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

 !"
#$%&"!'
(%&
)!*"+,-'"".
')!".!!"
!*)!./0
!*!))!))).
/0!$'!".'$%'
".
"+!
(1#-
"'!00!".23'3
!"3!"330'
.
'!'!!".
!3!3'.!
"*"+%-'!".4 .,%&0'
.
000!''5%+67-
Date of event_____________________ Address of venue________________________________
Type of event_____________________ ________________________________
Name__________________________________ Signature_________________________________
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Live daringly, boldly, fearlessly. Taste the relish to be found in competition – in having put forth the best within you. | Henry J. Kaiser