Official Pre Entry Form

Official PreEntry Form: $25 entry fee per division

Beach Entry: $40 entry fee per division

Name:____________________________

Age as of 1/1/09 ___________ DOB:______

Contest Entering (circle)     1  2   3   4   5   6

Open Men (16 & up) ___

Open Jrs (13-15) ___

Open Boys (12 & under) ___

Explorer Men (18-24) ___

Explorer Jrs (15-17) ___

Explorer Boys (13-14) ___

Explorer Women (15 & up) ___

Explorer Girls (14 & under) ___

Explorer LB (all ages) ___

I agree to hold harmless the NSSA and its affiliates for any injury I may incur as a result of my participation in any NSSA event. Signature ________________________ (parent or guardian signature if under 18 years of age)

mail to NSSA NE 1449 Joseph Ave Seaville NJ 08230