Dr.

Cue 3 on 3 Eight Ball Tournament Team Registration Form

April 6th, 7th, & 8th, 2018 at Decatur Conference Center & Hotel, 4191 US 36 West, Decatur, IL 62522

Team Registrations are not considered complete and official until all Team Fees are paid in full. TEAM - Minimum 3/Max 5 Total Fee $180.00
$150 Team Entry Fee
$30 Team Greens Fee

TEAM NAME : __________________________________TEAM #______________DATE:__________________
(APA USE ONLY)

DO NOT LEAVE ANY BLANK LINES. IF THERE ARE NOT 5 MEMBERS ON YOUR ROSTER, MARK AN X ON REMAINING SLOTS.

TEAM CAPTAIN NAME: MEMBER#:
ADDRESS:
CITY: STATE: ZIP: PHONE ( ) -
Other APA area(s) I am participating in:
8Ball Skill level(s) that I participate *Players
within this area(s): Signature:
NAME: MEMBER#:
ADDRESS:
CITY: STATE: ZIP: PHONE ( ) -
Other APA area(s) I am participating in:
8Ball Skill level(s) that I participate *Players
within this area(s): Signature:
NAME: MEMBER#:
ADDRESS:
CITY: STATE: ZIP: PHONE ( ) -
Other APA area(s) I am participating in:
8Ball Skill level(s) that I participate *Players
within this area(s): Signature:
NAME: MEMBER#:
ADDRESS:
CITY: STATE: ZIP: PHONE ( ) -
Other APA area(s) I am participating in:
8Ball Skill level(s) that I participate *Players
within this area(s): Signature:
NAME: MEMBER#:
ADDRESS:
CITY: STATE: ZIP: PHONE ( ) -
Other APA area(s) I am participating in:
8Ball Skill level(s) that I participate *Players
within this area(s): Signature:
* We each certify our representations in this form are true and correct to the best of our knowledge. By signing this form, we understand that purposely falsifying any
information may constitute disqualification from the Dr. Cue 3 on 3 Eight Ball Tournament and may include suspension or revocation of APA membership.
**Social Security numbers are used for tax purposes only and are kept confidential. The APA must have each team members Social Security number on file prior to any
prize money distribution.
LIABILITY RELEASE: WE HEREBY AGREE TO RELEASE THE DR. CUE 3 ON 3 8 BALL TOURNAMENT, DECATUR CONFERENCE CENTER AND HOTEL, CENTRAL ILLINOIS APA AND ANY OF
THEIR ASSOCIATED DIRECTORS, ADMINISTRATORS, OFFICERS, MANAGERS, EMPLOYEES, VOLUNTEERS, SPONSORS AND ADVERTISERS, AND OTHER AGENTS, ESTATES OR
EXECUTORS, FROM ANY AND ALL LIABILITY INCURRED IN THE CONDUCT OF, AND MY PARTICIPATION IN THE DR. CUE 3 ON 3 8 BALL TOURNAMENT. THIS INCLUDES OWNERS,
LESSORS, AND LESSEES OF PREMISES, MUNICIPALITIES, GOVERNMENT AGENCIES, SUCCESSORS, HEIRS, AND ASSIGNS. I HAVE COMPLETELY READ THIS DOCUMENT AND FULLY
UNDERSTAND ITS CONTENTS. I ACKNOWLEDGE THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY ACCEPTING THIS DOCUMENT AND THAT I DO SO VOLUNTARILY. MY
INFORMATION BELOW ATTESTS TO THIS ON BEHALF OF MYSELF AND MY EXECUTORS, PERSONAL REPRESENTATIVES, ADMINISTRATORS, HEIRS, NEXT - OF - KIN, SUCCESSORS,
AND ASSIGNS. WE ALSO STATE THAT WE ARE PHYSICALLY FIT TO PARTICIPATE IN THE DR. CUE 3 ON 3 8 BALL TOURNAMENT.