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STATE DIRECTOR

 

 

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ZONE DIRECTOR

 

 

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                         SANCTION FORM #                                                    DATE
Text Box: NSA Official Adult Roster

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                                                                                                    TEAM NAME                                                                    TEAM CLASS                                                                    CITY / STATE
Text Box: HUGH CANTRELL PRESIDENT (859) 887-4114 Text Box: NSA P.O. BOX 7 NICHOLASVILLE, KY 40340 Text Box: TEAM MANAGER AND PLAYERS READ THE FOLLOWING STATEMENT BEFORE COMPLETING AND SIGNING Text Box: In consideration of being permitted to participate in the N.S.A., I hereby agree for myself, successor, heirs and assigns, Release and forever discharge National Softball Association, Inc. (N.S.A.), their employees, officers, and directors from all claims, actions or judgements I may have or claim to have against N.S.A. for all personal injuries, including death, and injuries to property, real or personal, caused by or arising out of my participation in the N.S.A. - either Leagues or Tournaments. I further agree for myself, successor, heirs, and assigns to indemnify and hold N.S.A. harmless from all claims and suits for personal injuries, including death, Text Box: damages to property caused by act of omission arising our of participation in the N.S.A., and from all judgements recovered and from all expenses incurred in defending said claims or suits. I further agree that my photographs, pictures, slides or movies taken or made by N.S.A., their employees, officers and directors, in connection with my participation in the N.S.A. either Leagues or Tournaments, or any reproduction of the same, as well as my name, may in any manner be used by N.S.A., or by any person , corporation or association authorized by N.S.A. I am in good health and have no physical condition that would prevent me from participating in N.S.A. events. I, THE UNDERSIGNED, HAVE READ AND UNDERSTAND THE FOREGOING RELEASE. Text Box: N.S.A. Requirements: Roster must be signed by all players. The player is automatically ineligible if a signature appears on more than one roster, unless the player has a written release dated and signed by the team manager of the team for which the player will not be a member. The release must be filed with the Text Box: Regional Director before the teams play in a tournament leading to a State or National Championship. Team Rosters must be submitted to Regional Director upon Qualifying for State or National Championship. TEAM MEMBERS MAY BE ASKED TO PROVIDE A POSITIVE I.D. UPON REQUEST. Text Box: TEAM MANAGER AFFIDAVIT I am the manager of the above team and guarantee all of the information supplied above is correct to the best of my knowledge and that all of the players signed the above in their handwriting and they are eligible to compete with my team in the championship play of the NSA and agree to be bound by the rules and regulations of NSA. I also guarantee that if my team is a church team, all members of my team are members in good standing of the church that we represent. SIGNATURE OF CHURCH PASTOR OR ELDER ______________________________________________________________________________

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                             SIGNATURE OF TEAM MANAGER                                                         MANAGER’S NAME   (PRINT)

 

HOME PHONE (             ) __________________________________   _______________________________________________________

                                                                                                                                                MANAGER’S ADDRESS  (PRINT)

 

OFFICE PHONE (             ) _________________________________        _______________________________  _______   ____________

                                                                                                                                                         CITY                           STATE        ZIP

PRINT OR TYPE PLAYER’S NAME

PLAYER’S SIGNATURE

STREET ADDRESS   -  APT #

CITY

STATE

ZIP

DOB

DRIVERS LIC. #

(A/C) HOME PHONE

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