Meter Madness Contest Application
Please register me for the 2015 FSAWWA Fall Conference Meter Madness Contest.
(Please print clearly)
NAME: _____________________________________________________________________________________________
UTILITY: ___________________________________________________________________________________________
ADDRESS: __________________________________________________________________
CITY / STATE / ZIP: __________________________________________________________
EMAIL ADDRESS:____________________________________________________________
REGISTRATION FOR CONTESTAN, WAIVER, RELEASE
AND ASSUMPTION WAIVER:
By my signature below, I acknowledge that I have read this Waiver, Release and Assumption of Risk
and fully understand it’s terms, conditions and meaning.
In return for allowing my participation in the Florida Section AWWA Fall Conference “Meter Madness Contest”
activities, I voluntarily assume all risk and responsibility for my physical condition and for my injuries or damages to my person or property which I might sustain in that participation. I further voluntarily release and discharge
the Florida Section AWWA Fall Conference; it’s President, Officers, Employees, Members or Guests, for any
injury or damage to my person or property due to negligence, carelessness or any other fault. It is further understood that this Waiver, Release and Assumption of Risk is binding on my heirs, personal representatives, legal representatives, successors and assigns. I assume full responsibility for my actions and behavior during the Meter
Madness Contest and while in the Conference.
SIGNATURE: ___________________________________________________________
Signed this _____ day of ________________, 2015.
I am registered for the FSAWWA Fall Conference.
I have attached my Registration Form.
IN ORDER TO GUARANTEE YOUR SPOT AS A COMPETITOR, YOUR REGISTRATION
MUST BE RECEIVED BY NOVEMBER 06, 2015.
Fax Form to Paul Blastic at (407) 802-2504
For questions, please email Paul at pblastic@aol.com or call (407) 497-0587