2001 National Unicycle Convention Registration Form

2001 National Unicycle Convention Registration Form
July 16^th to 21^st, 2001 - Humber College, Toronto, Canada
Please use a separate form for each person
The USA Official Competition Rule Book will be used - All riders must be a member of the Unicycle Society of America

First Name:	____________________	Last Name	____________________	Date of Birth (mm/dd/yy)	_______________
Address:	_________________________________________________			Sex (circle one):	M F
City:	____________________	State/Prov:	__________________	ZIP/Postal Code:	__________
Country:	____________________	Phone:	(___)__________	E-mail:	____________________
Club Name:	____________________	USA #:	______________
If participant is under 18, name of parent/guardian/chaperone present at NUC 2001:				________________________________________

Registration (Registration fee includes entrance to all official NUC events, public show and use of all facilities)

Competitor Registration Fee (before March 1, 2001)	US $50.00	US$______
Late Competitor Registration Fee (March 1 to June 1, 2001)	US $65.00	US$______
Very Late Competitor Registration Fee (after June 1, 2001)	US $75.00	US$______
Non-Competitor Registration Fee	US $35.00	US$______

Extra Show Tickets (Tickets for the Wed night public show will be available at the door for C$10)
US $ 5.00 x _____ = US$______

NUC 2001 T-Shirts US $ 16.00 x _____ = US$______

____Youth Small ____Youth Med ____Adult Small ____Adult Med ____Adult Large ____Adult X-Large ____Adult XXL

Bus Transportation (from Humber College and back to Humber College)

To downtown Wed. July 18^th US $ 5.00…….. US$______

To York University Track & Field Centre Thu. July 19^th Fri. July 20^th US $ 5.00 x _____ = US$______

To Kelso Conservation Area for MUni Sat. July 21^st US $ 8.00…….. US$______

Dormitory Accommodation at Humber College. All accommodations are single rooms with air conditioning and phone and include full breakfast

Sun 15^th Mon 16^th Tues 17^th Wed 18^th Thu 19^th Fri 20^th Sat 21^st ____ nights x US $20.00 per night = US $________

Alternate accommodation including hotel and camping is also available

Meals at Humber College (Also available to participants who are not using Humber College accommodation)

Breakfast: (breakfast is included in cost for Humber College Dormitory Accommodation. If you've booked a dorm do not select breakfast)

Mon 16^th Tue 17^th Wed 18^th Thu 19^th Fri 20^th Sat 21^st Sun 22^nd ____days x US $ 6.00 = US$ ______

Dinner:

Sun 15^th Mon 16^th Tue 17^th Wed 18^th BBQ Thu 19^th Fri 20^st Sat 21^nd ____days x US $ 10.00 = US$ ______

Checks in US Funds payable to "National Unicycle Convention 2001" TOTAL US $ _______

(Canadian residents may pay in Canadian Funds at current exchange rates TOTAL C$ _________)

Please print this form.

Send the completed and signed form with a check for the full payment to:
(55¢ stamp required from United States)

Peter Groves
713 Markham Street,
Toronto, ON M6G 2M2, Canada

In consideration of the Unicycling Society of America, Inc., the host club, Toronto Unicyclists, Humber College, York University, the Corporation of the City of Toronto, and all other sponsors, agents, and representatives organizing and conducting the National Unicycle Convention from July 16^th to 21^st, 2001, and allowing me to participate in said event, I hereby waive, release, and discharge forever all above said organizations and their sponsors, agents, and representatives from all claims, demands, rights and causes of action of whatsoever kind and nature arising directly from any known/unknown, foreseen or unforeseen, bodily and personal injury, damage to property, and consequences thereof resulting from my participation in said National Unicycle Convention. I assume all risks of injury or mishap resulting from my participation and covenant, not to sue the aforementioned parties for said injuries and/or damage. I also permit USA and host club to provide furnish, or engage emergency medical treatment to me or my said son or daughter. I also give permission for the use of my name and/or picture in any broadcast, telecast, or other account of this event.

Emergency Contact Person: ___________________________________ Phone: (_____) ________________

__________________________________ _____________ _______________________________________

Signature Date Signature of Parent or Guardian

Please use a separate form for each person For questions on registration, please call Peter Groves at 416-531-3915 or e-mail at groves@pobox.com

Extra Show Tickets (Tickets for the Wed night public show will be available at the door for C$10)					US $ 5.00 x _____ = US$______
NUC 2001 T-Shirts					US $ 16.00 x _____ = US$______
____Youth Small	____Youth Med	____Adult Small	____Adult Med	____Adult Large	____Adult X-Large	____Adult XXL
Bus Transportation (from Humber College and back to Humber College)
To downtown		Wed. July 18^th			US $ 5.00…….. US$______
To York University Track & Field Centre		Thu. July 19^th	Fri. July 20^th		US $ 5.00 x _____ = US$______
To Kelso Conservation Area for MUni		Sat. July 21^st			US $ 8.00…….. US$______

Dormitory Accommodation at Humber College. All accommodations are single rooms with air conditioning and phone and include full breakfast
Sun 15^th	Mon 16^th	Tues 17^th	Wed 18^th	Thu 19^th	Fri 20^th	Sat 21^st	____ nights x US $20.00 per night = US $________

Breakfast: (breakfast is included in cost for Humber College Dormitory Accommodation. If you've booked a dorm do not select breakfast)
Mon 16^th	Tue 17^th	Wed 18^th	Thu 19^th	Fri 20^th	Sat 21^st	Sun 22^nd	____days x US $ 6.00 = US$ ______
Dinner:
Sun 15^th	Mon 16^th	Tue 17^th	Wed 18^th	BBQ Thu 19^th	Fri 20^st	Sat 21^nd	____days x US $ 10.00 = US$ ______

Checks in US Funds payable to "National Unicycle Convention 2001"	TOTAL US $ _______
(Canadian residents may pay in Canadian Funds at current exchange rates	TOTAL C$ _________)

__________________________________	_____________	_______________________________________
Signature	Date	Signature of Parent or Guardian