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Application for " D" Course MSYSA
PO BOX 667
Millersville, MD 21108
(410) 987-7898
Fax (410) 987-8707
U.S.S.F. “D” COURSE
July 18-19-20 & 25-26-27, 2008
At
River Hill High School
In
Clarksville, Maryland
APPLICATION FORM
NAME___________________________________________ AGE_______
ADDRESS____________________________________________________
CITY_____________________STATE____ZIP______________
PHONE: HOME ( ) ______________OFFICE/CELL_________________________
E Mail _________________________________________________________
Club Affiliation__________________________________________________
Please read this waiver carefully, and then complete it:
“I hereby authorize the staff of MSYSA to act according to their best efforts and judgment in any emergency requiring medical attention and I hereby waive and release MSYSA from any and all liability for any injuries or illness incurred while attending the course. I have no knowledge of any physical impairment that will affect my participation.”
Date__________________Signature_______________________________________
Questions: Bill Stara doc@msysa.org
Mail with $180 fee to: Linda Craig msysa@aol.com Payable to MSYSA
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