The Victorian Rock'n'Roll
Dance Association Inc.
Registered No: A0023069L

PO Box 58 Colac Vic 3250
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VRRDA.State Championships 2008  PO Box 58 Colac Vic 3250
Entry Form

Competitor Details
Partner 1
I, (Full Name)………………………………………………………………..
Address………………………………………………………………………
Phone……………………………………………....D/O/B……./……./…….
hereby release The Victorian Rock ‘n’ Roll Dance Association Inc. for any liability or claim against the Association or its Officers or it’s Delegated Officials arising from my competing in  The Victorian Rock ‘n’ Roll Dance Association Inc sanctioned dance competitions.  
I also acknowledge that I have read the Rules and have approached the officials of the VRRDA to have any queries dealt with and am satisfied with the information I have been given.
Signed..x……………………………………………Date……./……./…….
Witness
Name……………………Signature………………..Date……./……./…….

Partner 2
I,(Full Name)…………………………………………………………………
Address………………………………………………………………………
Phone……………………………………………....D/O/B……./……./…….
hereby release The Victorian Rock ‘n’ Roll Dance Association Inc. for any liability or claim against the Association or its Officers or it’s Delegated Officials arising from my competing in  The Victorian Rock‘n’Roll Dance Association Inc sanctioned dance competitions.  
I also acknowledge that I have read the Rules and have approached the officials of the VRRDA to have any queries dealt with and am satisfied with the information I have been given.

Signed..……………………………………………Date……./……./…….
Witness
Name……………………Signature………………..Date……./……./…….

Partner 3 (For Doubles)
I, (Full Name)…………………………………………………………………
Address………………………………………………………………………
Phone……………………………………………....D/O/B……./……./…….
hereby release The Victorian Rock ‘n’ Roll Dance Association Inc. for any liability or claim against the Association or its Officers or it’s Delegated Officials arising from my competing in  The Victorian Rock ‘n’ Roll Dance Association Inc sanctioned dance competitions.  
I also acknowledge that I have read the Rules and have approached the officials of the VRRDA to have any queries dealt with and am satisfied with the information I have been given.

Signed..x……………………………………………Date……./……./…….
Witness
Name……………………Signature………………..Date……./……./…….

Please tick the events you are entering:                    
- Youth Beginners (under 18 years)
- Youth Intermediate (under 18 years)
- Youth Advanced (under 18 years)
- Junior No Lifts (under 13 years)
- Teen No Lifts (13 years & over & under 18 years)
- Junior Lifts (under 13 years)
- Teen Lifts (13 years & over & under 18 years)
- Youth Triples (under 18 years)
- YOUTH STATE TITLE (UNDER 18 YEARS)

 - Adult Beginners (18 years & over)
- Adult Intermediate (18 years & over)
- Adult Advanced (18 years & over)

 - Young Adult No Lifts (18 years & over & under 35 years)
- Masters No Lifts (35 years & over & under 50 years)
- Nifty Fifties No Lifts (50 years & over)
- Adult Lifts (18 years & over)
-  Nifty Fifties Lifts (50 years & over)
- Adult Triples (18 years & over)
- ADULT STATE TITLE (18 YEARS & OVER)
                                                  Total number of events entered ......     Total Fees $........

I,………………………………being a person duly authorised to sign this form on behalf of …………………………………………………………. , who / which is a current financial member of  The Victorian Rock ‘n’ Roll Dance Association Inc. declare that the above entrants are current financial members of or students of or are being sponsored for this competition by, the above member, and are eligible for the events they have entered according to the rules governing this competition.
Signed..x……………………………………………………..Date……./……./