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14th Annual Tim Brauch Memorial Contest Pre-Registration Form September 22, 2012: BOWL CONTEST Lake Cunningham Regional Skate Park 2305 S. White Road San Jose, CA 95148 September 23, 2012: STREET CONTEST Scotts Valley Skate Park 361 Kings Village Road Scotts Valley, CA 95066 Name: ______________________________________________ Registering for which event(s): _________________________________________________ Age: ________ Date of Birth: _____________________ Address: ___________________________________________________________________ City: _______________________________ State: ____ Zip Code: _____________ Phone number: ______________________________________ E-mail address: ______________________________________ Sponsors: ___________________________________________________________________ Emergency Contact (Name and phone #): ___________________________________________ BY SUBMITTING THIS FORM YOU ARE RESERVING A SPOT FOR THE ABOVE MENTIONED CONTESTANT IN THE TIM BRAUCH MEMORIAL CONTEST, THIS DOES NOT GUARANTEE REGISTRATION IN THE EVENT. IN ORDER TO REGISTER YOU MUST REPORT TO THE SESSIONS BOOTH THE MORNING OF THE EVENT, BETWEEN 9:00AM & 10:30AM, TO SIGN A LIABILITY WAIVER AND PAY A $35 REGISTRATION FEE. Participant Signature _________________________________________ Parent/Guardian Signature ____________________________________ (if participant is minor) Please submit this form through email to or fax in to (831) 461-4680 Attn: Tim Brauch Registration

Tim Brauch Registration 2012

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