2018 SENIOR OLYMPICS SUMMER GAMES ENTRY …

1 192018 SENIOR OLYMPICSSUMMER GAMES ENTRY FORMATHLETE / GUEST (circle one)LAST _____ FIRST _____ADDRESS _____ CITY_____STATE _____ ZIP _____DATE OF BIRTH _____ GENDER q F q M MILITARY VETERAN q YES q NOETHNICITY: q CAUCASIAN q HISPANIC q NATIVE AMERICAN q AFRICAN AMERICAN q ASIANPHONE - HOME _____ PHONE - WORK/CELL _____E-MAIL _____T-SHIRT SIZE (DRIFIT-UNISEX):q SMALL q MEDIUM q LARGE q X-LARGE q 2X q 3 XEMERGENCY CONTACT _____(Preferably someone NOT attending SUMMER GAMES )PHONE - HOME _____ PHONE - WORK/CELL _____CHECKS, MC, VISA, AMEX, DISCOVER CREDIT CARDS ACCEPTED, CASH NOT ACCEPTED. Call NMSO office to pay by Mexico SENIOR OLYMPICS , Inc.

2 PO Box 2690 Roswell, NM 88202 888-623-6676 (575) 623-5777 Fax (575) 622-9244 E-mail: athletes and/or guests who will be staying in dorms or participating in events must complete ENTRY form on this page or register fields mustbe completedAll options are per person. Five Day Arrive Tue depart Sun Four Day Arrive Wed depart SunThree Day must be consecutive days, please Day must be consecutive days, please feesIndicate as of date post marked to NMSO Office IN STATEO nline closes at midnightOUT OF STATEB owling number of events _____Golf (includes cart)

3 Sport Dinner number of tickets _____Guest Pass number of passes _____ Guest Name _____Result BookMeals (please indicate code provided above) Example: M14 Dorms (please indicate code provided above) Example: S5/D5 Parking permit on UNM CampusConsider becoming a Friend of SENIOR OLYMPICS with yourdonation of any FEES DUE TO NMSOF ebruary 1 - May 31 $ 1 - June 8 $ 1 - May 31 $ 1 - June 8 $ $ per event$ $ $ $ Code _____Dorm Code _____$ a day / $ a week$$$$$$$$$$$$UNM HOUSINGLa PosadaAll meal plans begin w/lunchincludes $10 Dining BucksM14 14 meals/swipes =$ 11 meals/swipes = $ 9 meals/swipes = $ 6 meals/swipes = $ Single Double$39 per bed/ $32 per bed/per day per day S5 - $195 D5 - $160 S4 - $156 D4 - $128 S3 - $117 D3 - $96 S2 - $ 78 D2 - $64 DORMSMEALS(only needed for swimming,dorms and meals)

4 202018 SENIOR OLYMPICS SUMMER GAMESEVENT REGISTRATIONP lease register for events that are not held at the same time. The GAMES Management cannot guarantee you will be able to compete in all events. Mark (X) the event(s) you wish to enter. Refer to Sport Descriptions for dates, time and locations. Liability Waiver must be signed to complete registration process. Maximum of Five (5) Sports. PLEASE RETURN ALL 3 PAGES OF THE ENTRY GUN Jefferson Middle School q Pistol-Standing q Rifle-Standing q Pistol-Supported Position q Rifle-Supported PositionARCHERY Balloon Fiesta Park - North Field q Barebow Compound q Compound Fingers q Barebow Recurve q Compound Release q RecurveBADMINTON q Singles q Doubles _____Partner s Name q Mixed Doubles _____Partner s Name BOWLING Starlight Bowling @ Santa Ana q Singles q Singles - Non-Ambulatory q Doubles _____Partner s Name q Doubles - Non-Ambulatory _____Partner s Name q Mixed Doubles _____Partner s Name q Mixed Doubles Non-Ambulatory _____Partner s Name q Team M or W (not a)

5 National Qualifier) Captains Name _____Sub names _____ _____CYCLING Atrisco Vista Blvd NW/I-40q 5K q 10K q 20K q 40 KDANCE African American Performing Arts CenterLIMITED TO 2 DANCES PER CATEGORYB allroom Partner's Nameq Ballroom Waltz _____q Foxtrot _____Latin q Salsa/Mambo _____q Corrido _____q Rumba _____Swing Partner's Nameq Jitterbug _____q West Coast Swing _____Tangoq American Tango _____q Argentine Tango _____ Western Categoryq Western Two-Step _____q Western Waltz _____Miscellaneousq Night Club Two Step _____q Polka _____ Line Danceq Line Dance _____ Captains NameDISC GOLF Balloon Fiesta Park q Disc Golf (18 holes)8-BALL POOL Palo Duro SENIOR Center q 8-Ball PoolFIELD UNM Track Complex q Discus q Javelin q Shot Put q Hammer Throw q Standing Long Jump q High Jump q Pole Vault q Long Jump q Triple JumpFUN EVENTS MCM Elegant - no registration requiredGOLF UNM Championship Golf Course q GolfHORSESHOES Los Altos Park q Horseshoes q Horseshoes Non-AmbulatoryPICKLEBALL Manzano Mesa Park q Singles q Doubles _____Partner s Name q Mixed Doubles _____Partner s NamePOWER WALK - Balloon Fiesta Park q 1500M q 5 KRACE WALK - Balloon Fiesta Park q 1500M q 5 KRACQUETBALL Midtown Sports & Wellness q Singles q Doubles

6 _____Partner s Name q Mixed Doubles _____Partner s Name Athlete s Name (Please Print) National Qualifier Open to out of state 21 RECREATIONAL Various VenuesSee sport descriptionsq Basketball Free Throw q Basketball 3 Point Shotq Frisbee Accuracy Throw q Frisbee Distance Throwq Huachas (Washers) q Soccer Kick Accuracyq Softball Distance ThrowROAD RACE RUN Embudo Channel Trail q 5K q 10 KSHUFFLEBOARD Sid Cutter Pilots Pavilion Balloon Fiesta Park q Singles q Singles Non-Ambulatory q Doubles _____Partner s Name q Doubles Non-Ambulatory _____Partner s NameSWIMMING UNM Natatorium q 50Y Back q 50Y Free q 100Y Fly q 100Y Back q 100Y Free q 200Y Fly q 200Y Back q 200Y Free q 100Y IM q 50Y Breast q 500Y Free q 200Y IM q 100Y Breast q 50Y Fly q 400Y IM q 200Y Breast q 200Y Co-Ed Medley Relay (not a National Qualifier)

7 Teams can be formed on-site, must be registered for SUMMER GamesTABLE TENNIS Raymond Sanchez Community Center q Singles q Doubles _____Partner s Name q Mixed Doubles _____Partner s NameTALENT African American Performing Arts Center q Comedy Solo q Instrumental Solo q Comedy Group q Reading Solo q Dance Solo q Vocal Solo q Dance Group q Vocal GroupTENNIS Jerry Cline Tennis Complex q Singles q Doubles _____Partner s Name q Mixed Doubles _____Partner s NameTRACK UNM Track Complex q 50M q 800M q 100M q 1500M q 200M q 400M Estimated Run/Walk q 400M q 800M Estimated Run/Walk q 4 x 100M Co-Ed Relay (not a National Qualifier) Teams can be formed on-site, must be registered for SUMMER GamesTRIATHLON West Mesa Aquatics q 400M Swim/20K Cycling/5K Road Race q Co-Ed Triathlon Relay (not a National Qualifier)

8 Teams can be formed on-site, must be registered for SUMMER GamesNew Mexico SENIOR OLYMPICS , WAIVER In consideration of my being accepted in this event, I, the undersigned, intending to be legally bound, do hereby, for myself, my heirs, my personal representatives and assigns, waive release, and forever discharge any and all rights and claims for damages which I may have or may hereafter occur to me against all SENIOR Olympic SUMMER GAMES sponsors, or their officers, agents, representatives, successors and/or assigns or any other corporations or individuals associated with the New Mexico SENIOR OLYMPICS from any and all damages, claims, injuries or actions sustained or suffered in connection with my association or ENTRY in or arising out of my participation in said event.

9 If in doubt as to my physical condition to engage in this event, I have been advised to seek the advice of a competent physician, and to abide by his advice. I attest and verify that I have full knowledge of the risks involved in this event, and that I am physically fit and sufficiently trained to participate in this event. Further, I grant full permission to any and all the foregoing to use my likeness and photograph participating in this event without obligation or liability to me. I understand that my paid ENTRY fee is non refundable. Agreement to abide by Rules and Regulations. I agree to abide by all rules and regulations of the New Mexico SENIOR Olympic SUMMER GAMES , to observe all rules of play, to exercise good sportsmanship and follow all written or oral instructions given by authorized personnel of the GAMES .

10 I agree that failure to do so may result in my disqualification or suspension from the GAMES . All Athletes will sign in at every event. This signature is used for this liability FULL SIGNATURECity: _____Date: _____