Ontario Cup #2 and Canada Winter Games Selection ENTRY FORM

The Gloucester Concordes Speed Skating Club invites you to:
Ontario Cup #2 and Canada Winter Games Selection
ENTRY FORM/FEUILLE D INSCRIPTION
December 9-10 2006
Name of Skater/nom du patineur :
Sex/sexe :
Date of Birth/date de naissance (DD/MM/YY):
Age Class/catégorie d âge:
Club :
SSC Number/numero de l PVC:
Coaches Name/nom de l entraineur:
Coaches E-mail/courriel de l entraineur :
M or F
Canada Winter Games Selection - skaters must have reached the age of 14 on June 30, 2006 but have not reached the age of 19
on June 30, 2006. Year of Birth: July 1, 1987 to June 30 1992 inclusive. And skaters must meet Open A standards as a published in
Technical Bulletin #17 by December 2, 2006
Time in mm.ss.xx
500 m
1000 m
OR/OU
Ontario Cup #2- skaters must meet time standard as published in Technical Bulletin #17
Age Class
Pee Wee
Bantam
Midget
Juvenile
Junior
Open B
Distance
111
222
333
500
500
500
Time in mm.ss.xx
Distance
222
333
500
666
1000
1000
Time in mm.ss.xx
In consideration of my accepting this entry, I hereby, for myself, my heirs, executors, administrators and
assigns, waive and release any and all rights and claims for damages I may have against SSC, OSSA, the
Gloucester Concordes Speed Skating Club, their agents, officers, or members for any and all injuries suffered
by me at said competition to be held on December 09-10 2006 at Ottawa, Ontario.
Considérant l éventualité de l acceptation de ma demande, je renonce par la présente, pour moi-même, mes
héritiers, exécuteurs testamentaires et administrateurs, à tous les droits et toutes les réclamations pour
dommages subis contre l ACPVA, l OSSA, The Gloucester Concordes Speed Skating Club,leur agents, cadres
ou membres, pour toute blessure dont je pourrais être victime lors de la compétition qui aura lieu le(s) 09 et 10
december, 2006, á Ottawa, Ontario.
Signature of / du participant:
Signature of / du Parent or Guardian / ou tuteur (if / si participant is under 18 / à moins de 18 ans)
____________________________________________
In witness whereof, I have here unto set my and seal this _________ day of ___________________ 2006
En foi de quoi, j ai appose ma signature et mon sceau en ce ________ jour de _________________ 2006
The Gloucester Concordes Speed Skating Club invites you to:
Ontario Cup #2 and Canada Winter Games Selection
ENTRY FORM/FEUILLE D INSCRIPTION
December 9-10 2006
Sanctioned by OSSA/SSC
Sanctionné par OSSA/SSC
Location:
Orleans Recreation Complex
1490 Youville Drive,
Ottawa ON
Endroit:
Orleans Recreation Complex
1490 Youville Drive,
Ottawa ON
Check in: Friday, December 08 2006
18:30 20:00 Chimo Inn
Enregistrement: Vendredi le 08 Decembre 2006
18 :30 a 20 :00 Chimo Inn
Coaches Meeting: Friday at 20:30 PM
Chimo Inn
Rencontre des entraîneurs: Vendredi à 20:30
Chimo Inn
Warm Ups: 07:30, Dec 9 2006
Race Start Time: 08:30
Réchauffement: 0730 Dec 9 2006
Début des courses: 0830
Entry Fee: $ 45.00 per skater. Club cheque
only - payable to Gloucester Concordes
Frais d enregistrement: $ 45.00 par patineur,
Un chèque par club, payable au nom de:
Gloucester Concordes
Club Registration Deadline: In our
possession, Wednesday, Nov 29, 2006 by
22:00. Late entries will not be accepted. Club
must register on the OSSA Club Registration
form.
Date limite d enregistrement: Dans notre
possession, le 29 Novembre 2006 par 2200.
Auccun enregistrement ne sera accepté après la
date limite. Les Clubs doivent s enregisterr sur la
forme official de OSSA.
Entries e-mailed to: [email protected]
Phoned to: Susan Cook (613)-240-7498
Phoned entries must be guaranteed.
Enregistrement courriel: [email protected]
Par téléphone: Susan Cook (613) 240-7498
Les inscriptions par téléphone doivent être
guarentis.
Accommodation:
Chimo Hotel, 1199 Joseph Cyr Street,
Ottawa
800-387-9779/613-744-1060
www.chimohotel.com
$105 if booked prior to Nov 24 2006
Accommodation:
Chimo Hotel, 1199 Joseph Cyr Street, Ottawa
800-387-9779/613-744-1060
www.chimohotel.com
$105 chaque nuit apres de 24 Nov 2006