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Online Event Registration and Payment

Tournament of Champions


PayPal

Tournament of Champions
Atlanta Masonic Center, Atlanta GA
February 4, 2017

Registration Closes: January 20, 2017

Please Note: * indicates a required field


Registration Information

What registration package would you like?

Choose Package:

Package A (Competitor) - $35.00
Package B (Dinner/Dance Only) - $15.00

 

Do you have a voucher for a registration discount?

Discount Code:


Demographic Information

Last Name:

*

First Name:

*

Middle Name:

Name on Badge:

enter name how you want it to appear on name badge

E-Mail:

*

 

Please ensure that your e-mail address is correct.
A confirmation of your transaction will be sent to this e-mail address.

Address:

*

Address 2:

City:

*

State:

*

ZIP Code:

*

Phone:

xxx-xxx-xxxx

Date of Birth:

*

Chapter:

*

Category:

*

Chaperone:

note chaperone if Sweetheart, Rainbow, or Minor Female Guest was selected above

T-Shirt Size:

*


Emergency Contact Information

Primary Contact

Contact Name:

*

Contact Phone:

* xxx-xxx-xxxx

Alternate Phone:

xxx-xxx-xxxx

Secondary Contact

Contact Name:

Contact Phone:

xxx-xxx-xxxx

Alternate Phone:

xxx-xxx-xxxx


Medical Insurance/Health Information

All fields in this section are required. Check the "uninsured" box if you do not have medical insurance.

Uninsured?:

check this box if you do not have medical insurance

Insurance Company:

*

Policy Holder Name:

*

Member ID#:

* may also be called Subscriber or Policy ID

Group ID#:

* if there is no Group ID, enter "none"

 

 

Allergies:

* list all known medication and food allergies; enter "none" if necessary

Medications:

* list all current medications, including dose, frequency, and reason; enter "none" if necessary

Health Problems:

* list all known health conditions; enter "none" if necessary


Terms and Conditions

Refund Requests
No refunds will be granted after January 20, 2017.

Advisor Approval Required
An advisor from the registrant's Chapter must attend the event to supervise this registrant, if the registrant is an active DeMolay or another young man for which supervision would be appropriate. For a Sweetheart, Rainbow, or Minor Female Guest, an advisor must select a qualified, approved chaperone to attend to supervise the Sweetheart or minor female guest. An advisor of each Chapter will be contacted approximately two weeks prior to the event to approve all registrants for that Chapter. If the advisor does not approve a registrant to attend the event for a valid reason, a full refund will be issued and the registrant will not be allowed to attend the event.

Prohibited Items
DeMolay Functions are drug, alcohol, and weapon free. Georgia DeMolay reserves the right to search any bag or room for cause. Registrants who are in possession of prohibited items will be removed from the event without refund.

Event Release
In the event of injury or illness to my son, daughter, or ward, I hereby authorize and direct DeMolay advisor(s) supervising the activity in which the above named youth is participating, to secure medical treatment, including, but not limited to, hospitalization, injections, anesthesia, and surgery for my son, daughter, or ward; thereby authorizing a supervising DeMolay advisor to sign and consent thereto as fully as I could were I personally present. I acknowledge that I will be responsible for payment of all charges related to the medical services provided. As parent or guardian of the registrant, I further agree to indemnify and hold harmless the Associated DeMolay Chapters of Georgia (aka Georgia DeMolay), and any adult advisors and/or volunteers who have agreed to supervise the activity for which my son, daughter, or ward is registering, from any damages recovered or recoverable by my son, daughter, or ward. Furthermore, I agree that, upon notification from an authorized adult DeMolay advisor or other volunteer assisting with the event at which my son, daughter, or ward is a participant, to remove my son, daughter, or ward, if, in the opinion of the supervising adults, it is deemed necessary and appropriate that he/she be removed from the activity site. I also agree on behalf of my son, daughter, or ward that, if it is deemed necessary by DeMolay advisors supervising the activity, his/her room may be entered and an inventory of his/her personal effects performed by no fewer than two DeMolay advisors. By allowing registrant to attend the event, I fully understand the above and agree to abide by its terms.


Electronic Signature

Instructions

  • If the registrant is under 18, the registrant's legal guardian must e-sign below.
  • If the registrant is 18 or older, the registrant must e-sign below.
  • Read the statement below and enter your name in the e-sign box to electronically sign your name.

"By entering my name below, I hereby state that I am over 18 years old and the legal guardian of the registrant listed above. I have read and agree to all of the above terms and conditions."

E-Sign: *

(be sure to read all terms and e-sign above before clicking "Continue")

 Online Event Registration and Payment
 http://gademolay.org/calendar/toc2017.html

Last Modified: 22 January 2017 
Copyright © 2017, Georgia DeMolay