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Florida Half Century Amateur Softball Association, Inc

Registration Application
Please Type or Print Legibly
2017

Registration Fee (USD): $50.00
REVISED: February 2, 2017
NAME Date
Permanent Home Address:
City County State Zip
Telephone Number FIa. Driver’s License
Date of Birth Where Born(Country)
City Country State
Note: APPLICANTS MUST SUBMIT ONE OF THE' FOLLOWING DOCUMENTS VERIFYING DATE OF BIRTH: Original Birth Certificate, Original Certificate of Birth Registration, or Original Passport (Can be expired}, or Original Baptismal Certificate. Original will be returned to the Applicant. Additionally, a certified or notarized copy of the above mentioned documentation will also be acceptable.
Additionally, the applicant must submit a legible copy of both sides of their driver’s license.
Part Time Florida Residence: How Long? From: To:
Address: Fla. Tel. Nbr:
City: Country: ZIP:
Team Affiliation:
VOLUNTARY DISCLOSURE CONSENT: I hereby certify that the above information is correct and I further agree that the information may be verified through direct contact with the records bureau at the location of my birth or through the U.S. Immigration and the Naturalization Service. Falsification of docmentation sball result in denial of membership.
Signature of Applicant
RETURN WITH CHECK PAYABLE TO: Florida Half Century ASA, Inc.
MAIL TO: Mike Knowles          941-725-0790
               3806 30th Lane E
               Bradenton, FL 34208

Florida Half Century Amateur Softball Association, Inc

WAIVER AND RELEASE OF LIABILITY FORM

I acknowledge that softball or any sporting event is an extreme test of a person’s physical and mental limits and carries with it the potential of death, serious injury, or property loss.

I HEREBY ASSUME THE RISKS OF PARTICIPATION IN A SOFTBALL EVENT.

I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns:

a) I waive, release, and discharge from any and all claims of liability for death or personal injury or damages of any kind all representatives of the Florida Half Century Amateur Softball Association, Inc.

b) I agree not to sue any representative of the Florida Half Century Amateur Softball Association, Inc. or the association for any claims or liabilities that I have waived, released, or discharged herein.

c) I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.

BY SIGNING THIS FORM, I AFFIRM THAT 1 AM FIFTY (50) YEARS OF AGE, OR WILL ATTAIN THAT AGE DURING THIS CALENDAR YEAR, OR OLDER, AND THAT I WILL OBEY THE RULES, REGULATIONS AND BYLAWS OF THE ASSOCIATION. I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENTS.
Printed Name Date