Douglas County’s Christian Radio presents the “ICTHUS” PING PONG Tournament!

OFFICIAL ENTRY FORM FOR “Adult Women & Men” PLAYERS. (Youth players fill out separate form)

The Tournament takes place on Saturday, April 22nd at 9:30 AM to 6:00 PM at the UVCS GYM in Dixionville.

We only have space for 12 players in each one of the brackets for Men, Women and Youth (13 to 18 years). Please

carefully read over the OFFICIAL Player’s Rules. Sign and return this form to signify your interest in having your chance

to have your name drawn as a player. (Each bracket allows a maximum of 12 players selected by a lottery drawing)

There is no entry fee.

All players must fill-out and return the OFFICIAL AM-700 Radio Entry Form. Download at www.kgrv700.net or

contact the station directly by phoning 541-679-8185. Certain Rules and restrictions apply for all players.

Must register & return Entry Form to KGRV Radio by Friday, April 7th.

All participants must be an attender of a Douglas County Christian church!

NOW HERE ARE THE PRIZES TO BE AWARDED:

Prize for winner of Men’s Bracket: 2 night’s Lodging at SHILO INNS

Prise for winning Lady’s Bracket: $150.00 gift certificate for Harvard Avenue Drug & Gifts

Prize for winner of Youth Bracket: Diamond Lake Charter boat fishing & lodging package for 2 (accompanied by an adult)

This is the adult Entry form. Our Youth Entry Form may be found at kgrv700.net or at the station!

I _______________ residing in ______________ an attender of ______________________ have read & understood the

(PRINT your name here) (home city) (name of sponsor church)

Official rules for this tournament as displayed at KGRV website. I agree to abide and submit to the referee’s calls during

event play. I agree to be available for the entire day (9:30 am –6:00 pm) unless I do not advance as a winner.

______________ _______________ __________________________ _____________________

(My best phone #) (back up phone # ) (mailing address) (email address for station use)

RETURN to KGRV Radio by mailing (po box 1598 Winston, OR 97496) or email as attachment (info@kgrv700.net) Be sure

to phone the station once you have sent it to make sure it was processed at 541-679-8185.

On the date April 10, 2017, station staff will randomly draw for our player’s names by lottery at the UVCS Campus!

Then KGRV will contact these 36 persons the next day!

As one of 36 tournament players, I agree to allow KGRV Christian Radio AM-700 to broadcast my name and

post pictures taken at the ICTHUS Table Tennis event at the station website: www.kgrv700.net.

____________________________ ______________________________

(Any medical conditions to declare?) (signature of player here)