June 3 - 17Registration Deadline May 19, 2017

On-line Registration Available

Wisconsin Senior Games

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AcknowledgmentsWe thank the many volunteers who have given their time and talents to make theWisconsin Senior Games what they are today. We look forward to an exciting twoweeks filled with athletics, camaraderie, and memories once again.

A special thank you to Wells Printing & Digital Services and Athens to Atlantis fortheir support and partnership.

Wisconsin Senior Games is proudly supported by All Saints Neighborhood.

Making a DifferenceThe Wisconsin Senior Games wants to sincerely express our gratitude to the partici-pants who made a donation to our organization."It really does make a difference." Thank you!

John R OlsonPaul C. AspinwallReggie J. HennesseyJack SorensonWilliam S JankovichDon SingerRussell W. CraneJames B. SchommerDu Wayne A KittlesonMonte K HottmannBob Mc CoidGen EngelRobert H BerningerIvy H DowdSilas JohnsonPatrice L. NicoletDennis E DowdFrank W. KilpatrickRichard G. BelshawJohn QA SmithDave DydahlTom M. AndersonLyle W. HariedFrank A. BalistreriEmy ImhoffLarry W QuamRose StuvetraaHerman TorosianDonald A. SchultzPatrick CampbellJeanine C. MalyJohn K. BaumannGary SchillDavid W. LesniakNeil F. MilbertJerry L. CappsPeder N. Melhuse

Donald W. OlmanMichael J. GehnMary A. SchickCarol J. PedersonBruce C. KellyAndrew G. HomburgChuck K HenriksonDonald HoeppnerGary MillGloria ProsaGregg C Fergus

Harold S TetzlaffJerry BlevinsJohn C NeupertLyndon (lynnie) S ClemensMary P ErdmanMichael J BerndtMichael J HellerPamela StanglScott P ErwinThomas CharkowskiTom R Berg

MSCR Goodman-Rotary 50+ Fitness

204-3000 or www.mscr.org

Recreation for all ages! Arts & Enrichment • Youth Sports

Adult Sports • Fitness • Soccer Adaptive Sports • Paddling & Boating

Swimming, Tennis and more!

A variety funof activities! Core & Balance,

Outdoor Endeavors, Kayaking, Strength,

Dance, Fitness, Tai Chi, Walking Yoga and more!

1845 Bus. Hwy. 151 & 18 east Mt. Horeb, Wisconsin 53572Phone: (608) 437-3081

210 South Main StreetVerona, Wisconsin 53593Phone: (608) 845-6478

YOUR FAMILY GROCERLike us on Facebook!

P E R S O N A L T R A I N I N G

FREE TWO Week Membership

N U T R I T I O N counseling

Lap SwimmingWhirlpoolSteam RoomSauna

Exercise ClassesBasketballRacquetballVolleyballExpires 8/31/17

OPEN24 HOURS

ONLY $29/mo COTTAGE GROVE 1609 Landmark Lane

608-839-6300

FITCHBURG 5956 Executive Drive608-441-7000

HILLDALE 625 N. Segoe Road608-442-5400

MCFARLAND 5720 US Highway 51608-838-1072

MONONA 5413 Monona Drive608-663-2639

MIDDLETON 2510 Allen Blvd.

608-203-9444

1 2017 WISCONSIN SENIOR GAMESOn-line registration available

The 2017 Senior GamesWisconsin Senior Games offers competitive events in the Madison Area.The 2017 games are held from June 3th to June 17th and are for adultsage 50 and over. Events are divided by age brackets and men’s andwomen’s categories. Participants may choose to enter any number ofevents. Team events include volleyball, basketball, and softball. Seewww.wiseniorgames.org for more details and the latest information.

General Requirements and RulesRegistration: Registrations for all events must be postmarked on or before the

deadline. This year the registration deadline is May 19, 2017. On-siteregistrations may be accepted at the discretion of the event chairperson.Wisconsin residency is not required.

T-Shirts: All active participants, who have registered by the registration deadline,will have the option to get a t-shirt. Shirts will be distributed at eachparticipant’s first event. If participant has not registered by the registrationdeadline the Wisconsin Senior Games cannot guarantee a t-shirt.

Minimum Age: Participants must be at least 50 years of age on December 31st 2017.

Check In: Participants are asked to check in at each event site one-half hour beforethe event begins.

Walk-in Participant: If allowed by event chair, must be paid in check or cash. No credit cards atevent sites.

RulesParticipation Divisions: There will be separate men’s and women’s competition in the following

events: Basketball (3 on 3), Basketball Skills, Bowling, Golf, Pool,Pickleball, Swimming, Tennis, Table Tennis, Track & Field, and Volleyball.

Age Categories: The events can have either 5-year, 10-year or no age categories. Age cat-egories start at the age of 50.

Awards: The top three participants in competitive events in each age group willreceive awards following the event. If fewer than three participants areentered in a category, age categories may be combined.

Inclement Weather: Wisconsin Senior Games reserves the right to cancel events due to inclementweather. In case of bad weather, events may or may not be rescheduled and refundsmay or may not be provided.

Registration Form: Each participant must complete a Wisconsin Senior Games registration form and signand date the Waiver and Release of Liability Clause. Failure to complete and providethis form may lead to disqualification.

Please note: Wisconsin Senior Games reserves the right to combine age and gender brackets, or tocancel events due to limited registrations.

Extra registrationform: for friend

or family

2017 WISCONSIN SENIOR GAMES 2 On-line registration available

Specific Event Requirements

All Events: Please check in at your event location at least30 minutes before the event is scheduled to begin.

Basketball (3 on 3): Each team must wear shirts of identical color. Gym shoes are required.Team registration is required.

Bowling: Be sure to enter your bowling average on the registration form.

Golf: If you desire specific tee time or to play with a pre-arranged foursome,call Mark Hanson, 608-239-8332 before June 5th.

Pickleball: There are singles, doubles, and mixed doubles events. There will be three agedivisions: 50-59, 60-69, and 70 and over. Please come one-half hour early.Paddles, nets, and balls are provided.

Slow Pitch Softball: This is a team sport played under Senior Softball Slow Pitch Rules. There willbe two age divisions: 50-64 and 65 and over.PLEASE NOTE: In addition to the individual registration form, a teamregistration form is also required (see team registration form).No metal spikes allowed. Game balls will be furnished. Teams must furnishall other equipment.

Table Tennis: Bring your own paddles if you have them.

Tennis: For 2017, tennis will be men’s doubles, women’s doubles, and mixed doublesonly. Partner’s name must be included on registration form.

Volleyball: This is a team sport for men or women.PLEASE NOTE: In addition to the individual registration form, a teamregistration form is also required (see team registration form).National Senior Rules apply. Teams must provide practice balls.

Please note: Wisconsin Senior Games reserves the right to combine age and gender brackets,or to cancel events due to limited registrations.

3 2017 WISCONSIN SENIOR GAMESOn-line registration available

2017 Event ChairpersonsBasketball (3 on 3) Reggie Hennessey 608-274-6842 president@wiseniorgames.org

Basketball Skills John Schultz 608-231-2309(free throws, three-point shot, hot shots)

Bowling Bob Frambs 608-222-9204 Frambsbob@yahoo.comJohn Smith 608-222-0134

CARDS

Sheepshead (Monona Sr. Ctr.) Jerry Fuller 608 846-5533 bjfuller@centurytel.net

Cribbage (Fitchburg Senior Ctr.) Mike Procknow 608-437-7610 maprocknow@gmail.com

Euchre (Stoughton Sr. Ctr.) Mike Procknow 608-437-7610 maprocknow@gmail.com

Euchre (Middleton Sr. Ctr.) Mike Procknow 608-437-7610 maprocknow@gmail.com

Euchre Mike Procknow 608-437-7610 maprocknow@gmail.com (Warner Park Community CTR)

Euchre Mike Procknow 608-437-7610 maprocknow@gmail.com (All Saints Neighborhood)

Dart Ball Lynn Forshaug 608-437-6902 swdaneoutreach@mounthorebwi.info

Golf Mark Hanson 608-239-8332 hanson.mark.ed@gmail.com

Pickleball Fred Fry 608-764-5207 fry-fk@charter.net

Pool - 8 Ball Allen McCredie 608-332-1823 woodsmaster41@gmail.com

Softball–Slow Pitch Reggie Hennessey 608-274-6842 president@wiseniorgames.org

Swimming Deb Stevens 608-221-2779 CDML4910@charter.net

Table Tennis Michael Berndt 608-692-2061 attymjb@aol.com

Tennis Dennis Dowd 608-698-5559 dendowd@yahoo.com

Track & Field Travis Bashaw 518-632-4394 travis@wiseniorgames.orgJohn Schultz 608-231-2309

Trap & Skeet Larry Quam 608-873-3578 lquam@att.netTom Lunde 608-873-7013

Volleyball –Men Nancy Gille 608-277-1943 nanniegille@hotmail.com

Volleyball –Women Nancy Gille 608-277-1943 nanniegille@hotmail.com

2017 WISCONSIN SENIOR GAMES 4 On-line registration available

FitchburgLOCATION STREET ADDRESS PHONE DIRECTIONS

Ten Pin Alley, 6285 Nesbitt Rd 608-845-1010 From Hwy 18 & 151, West side of Madison,Fitchburg turn West on CTH “PD”. McKee Road, a traffic

light, turn left at next traffic light. Nesbit Roadand travel 0.7 mile to the alleys.

Fitchburg Senior Ctr 5510 Lacy Rd 608-270-2940 Fish Hatchery Rd. south off beltline 2-1/2miles, left on Lacy Rd. for ¼ mile. SeniorCenter is in lower level of Community Center.

MadisonLOCATION STREET ADDRESS PHONE DIRECTIONS

All Saints 511 Commerce Dr 608-827-2772 West Beltline- exit Gammon Rd, go south- turn rightNeighborhood onto Watts Rd- left onto Commerce Drive and left to

building 511 Commerce.

Bowl-A-Vard 2121 E Springs Drive 608-244-7246 Near East Towne Mall, across from Menards

Dream Lanes 13 Atlas Court 608-221-3596 Take Stoughton Road (Hwy. 51) to Cottage Grove Rdexit. Head east to stoplight at Atlas (by Culver’s)and turn left, then first right to Atlas Court.

Madison Memorial 201 South Gammon Rd North on Gammon off BeltlineHigh School

Madison Table 2100 Winnebago St East Washington Ave to S. First St, 1 block,Tennis Club turn left onto Winnebago St, then straight

ahead to Madison Table Tennis Club (turn left intoFord Gym parking lot)

Powless Tennis 801 Struck Street Beltline Hwy to Gammon Road Exit, south onCenter Gammon to Watts Rd, left on Watts, right on Struck St

Princeton Club-East 1726 Eagan Rd 608-241-2639 East Washington Ave. to Eagan Rd

Princeton Club-West 8080 Watts Rd 608-833-2639 Beltline Hwy to Gammon Rd,exit south on Gammon Rd, right onWatts Rd to Princeton Club West

Pitcher’s Pub 323 W. Beltline Hwy 608-271-9702 Enter via Rimrock Rd., right east Badger Rd.

Schwoegler’s 444 Grand 608-833-7272 Mineral Point Rd to Grand Canyon DrEntertainment Ctr Canyon Dr

Warner Park 1625 Northport Dr 608-245-3690 From Hwy 30, exit right to Packers Ave., PackersCommunity Ctr curves left to Northport Drive, left to Warner Park

Recreation Center

MiddletonLOCATION STREET ADDRESS PHONE DIRECTIONS

Bowling Green 7622 Lisa Ln 608 -831-5556 US 12-18, exit Parmenter Street,Softball Complex continue to Lisa Lane

Middleton Senior 7448 Hubbard Ave 608-831-2373Center

2017 Wisconsin Senior Games Site Locations

5 2017 WISCONSIN SENIOR GAMESOn-line registration available

MononaLOCATION STREET ADDRESS PHONE DIRECTIONS

Monona Senior 1011 Nichols Rd 608-222-3415 Take beltline to Monona Dr., then head NorthCenter on Monona to Nichols Rd (a Light), then left

on Nichols Rd. to #1011.

Monona Golf Course 111 E Dean Ave. Take beltline to Monona Dr, then head northon Monona and take a right onto Dean Ave.

Mt HorebLOCATION STREET ADDRESS PHONE DIRECTIONS

Mt. Horeb Senior 107 N Grove St 608-437-6902 Hwy 18/ 151 west to the Mt, Horeb CountyCenter Route ID exit. Go thru two stop lights and take

the next turn right. The Community Center is inthe lower level of the Library.

StoughtonLOCATION STREET ADDRESS PHONE DIRECTIONS

Stoughton 918 Collins Rd 608-877-1047 From Highway 51 on East side ofConservation Park Stoughton, go south and east on CTH “A” to

Collins Road. Turn south on Collins Road to918. Park is on left.

Stoughton Senior 248 W. Main St 608-873-8585 Next to the bridgeCenter

Sun PrairieLOCATION STREET ADDRESS PHONE DIRECTIONS

Prairie Athletic Club 1010 N Bird St 608-837-4646 Hwy 151 east from Madison to 3rd Sun Prairie exit(Bird St). Turn left on Bird to Club

WaunakeeLOCATION STREET ADDRESS PHONE DIRECTIONS

Waun-A-Bowl 301 S Century Ave 608-849-5941 Main Street to round-about south onCentury Ave.(Hwy Q)

2017 Wisconsin Senior Games Site Locations CONTINUED

2017 WISCONSIN SENIOR GAMES 6 On-line registration available

Check the box EVENT AM PM WHERE

Sat. June 3 1 Skeet 8:30 AM Stoughton Conservation Park Rain Date 6-42 Trap 9:30 AM Stoughton Conservation Park Rain Date 6-43 Track -50 meter dash 9:00 AM Memorial High School, Madison4 Track -100 meter dash 9:00 AM5 Track -200 meter dash 9:00 AM6 Track -800 meter race walk 9:00 AM7 Field -Discus Throw 10:00 AM Memorial High School, Madison8 Field -Softball Throw 10:00 AM9 Field -Standing Long Jump 10:00 AM

10 Field -Shot Put 10:00 AM11 Field -Turbo Javelin Throw 10:00 AM

Mon. June 5 12 Cards-Cribbage 1:00 PM Fitchburg Senior Center13 Bowling 10:00 AM Bowl-A-Vard, Madison

Tues. June 6 14 8-Ball Pool 12:00 PM Pitcher’s Pub, Madison15 Cards-Euchre 1:00 PM Stoughton Senior Center16 Dart Ball 1:00 PM Mount Horeb Senior Center

Wed. June 7 17 Pickleball – Singles (Men) 10:00 AM Prairie Athletic Club (Sun Prairie)18 Pickleball – Singles (Women) 10:00 AM Prairie Athletic Club (Sun Prairie)19 Pickleball - Doubles (Men) 12:30 PM Prairie Athletic Club (Sun Prairie)20 Pickleball - Doubles (Women)* 12:30 PM Prairie Athletic Club (Sun Prairie)21 Pickleball - Mixed Doubles 5:30 PM Prairie Athletic Club (Sun Prairie)22 Table Tennis 12:30 PM Madison Table Tennis Club23 Cards-Euchre 1:00 PM All Saints Neighborhood24 Bowling 6:15 PM Schwoeglers Entertainment Center

Thurs. June 8 25 Cards-Euchre 1:00 PM Middleton Senior Center26 Basketball-Free Throw 6:00 PM Princeton Club West27 Basketball- Hot Shots 7:00 PM Princeton Club West28 Basketball-3 Point Shot 8:00 PM Princeton Club West

Friday June 9 29 Swimming 25m Breast Stroke 1:00 PM Princeton Club West30 Swimming 50m Breast Stroke 1:00 PM Princeton Club West31 Swimming 25m Back Stroke 1:00 PM Princeton Club West32 Swimming 50m Back Stroke 1:00 PM Princeton Club West33 Swimming 25m Free Style 1:00 PM Princeton Club West34 Swimming 50m Free Style 1:00 PM Princeton Club West35 Volleyball (Men) 5:30 PM Princeton Club East36 Volleyball (Women) 5:30 PM Princeton Club East37 Bowling 6:15 PM Ten Pin Alley, Fitchburg

Sat. June 10 38 Softball-slow pitch 10:00 AM Bowling Green Softball Complex Rain Date 6/17

Wed. June 14 39 Golf-9 holes 10:00 AM Monona Golf Course40 Bowling 6:15 PM Dream Lanes, Madison

Thurs. June 15 41 Tennis-Doubles (Women) 10:30 AM Powless Tennis Center, Madison42 Tennis-Doubles (Men) 10:30 AM Powless Tennis Center, Madison43 Cards - Euchre 1:00 PM Warner Park Community Center44 Bowling 3:00 PM Waun-A-Bowl, Waunakee45 Basketball (3 on 3) 6:15 PM Princeton Club West

Fri. June 16 46 Cards-Sheepshead 8:00 AM Monona Senior Center47 Tennis-Mixed Doubles 10:30 AM Powless Tennis Center, Madison

Key:Fee at Event

Team RegistrationForm Required

Note Site Change

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Wisconsin Senior Games 2017 Registration Form – Must be post marked by May 19, 2017 Page 1 of 2Please print legibly. Thank you! Updated April see www.wiseniorgames.org for online registration NAME First Name

MI

Last Name

ADDRESS

Street

City

State

Zip Code

CONTACT INFORMATION Home Phone

( ) Work Phone

( )

Emergency Contact Name

Emergency Contact Phone

( ) Email Address

This email address may be used to send you information about the Wisconsin Senior Games activities before, during, and after the games.

Check here if you do not want to receive such emails. ATHLETE INFORMATION

Gender M F

Date of Birth – Month/Day/Year / /

M M D D Y Y Y Y

Age on December 31st 2017

Failure to provide age and DOB info may result in rejection.

Wisconsin Senior Games 2017 Shirt No, I do not want a shirt

Yes, I want a shirt

If, you answered “Yes” for a shirt, circle the size

S M L XL XXL XXXL Bowling Average (if bowling) _________

Team Sports – Fill in only if you are on any of the team sports below* Tennis Doubles

Partner Name*

Pickle ball Doubles

Partner Name*

Softball Captain Name*

Team Name*

Volleyball Captain Name*

Team Name*

Basketball (3 on 3)

Captain Name*

Team Name*

*If you would like to be on a team, and do not have enough participants, please contact the event chairperson for assistance (see pg 3)

EVENT SELECTION – Put an ‘X’ by the event(s) in which you will be participating. Please also mark the same events on your schedule.

1 Skeet 2 Trap 3 Track-50 meter dash 4 Track-100 meter dash 5 Track-200 meter dash 6 Track-800 meter walk 7 Field-Discus Throw 8 Field-Softball Throw 9 Field-Standing Jump 10 Field-Shot Put 11 Field-Turbo Javelin 12 Cards-Cribbage 13 Bowling- Bowl-A-Vard

14 8-Ball Pool 15 Cards-Euchre,

Stoughton 16 Dart Ball 17 Pickleball–Singles(M) 18 Pickleball–Singles(W) 19 Pickleball-Doubles(M) 20 Pickleball-Doubles(W) 21 Pickleball-Mixed

Doubles 22 Table Tennis 23 Cards-Euchre 24 Bowling- Schwoeglers 25 Cards-Euchre

26 Basketball-Free Throw27 Basketball- Hot Shots 28 Basketball-3 Point

Shot 29 Swimming 25m Breast30 Swimming 50m Breast31 Swimming 25m Back 32 Swimming 50m Back 33 Swimming 25m Free 34 Swimming 50m Free 35 Volleyball(M)

36 Volleyball(W) 37 Bowling 38 Softball-slow pitch 39 Golf-9 holes 40 Bowling-Dream Lanes 41 Tennis-Doubles (W) 42 Tennis-Doubles (M) 43 Cards - Euchre 44 Bowling 45 Basketball(3 on 3) 46 Cards-Sheepshead 47 Tennis-Mixed Doubles

Wisconsin Senior Games 2017 Registration Form – Must be post marked by May 19, 2017 Page 2 of 2EVENT REGISTRATION COSTS see www.wiseniorgames.org for online registration The first event is $12 ($10 for cards) and $5 for each additional event. Wisconsin Senior Games Special Offer: Unlimited events for $40.00 (excludes on-site fees). DETERMINE YOUR COST For each item that applies, enter that amount in the subtotal to the right. No. ITEM ACTION REGISTRATION COST/EVENT SUBTOTAL 1 1st Event $12 ($10 for Cards) $

2 Activity Events Additional Events

# of additional Events Multiply by $5 per event $

3 Add the subtotals from lines 1 and 2 $ 4 Enter the lesser of the the total of line 3 or $40 (the WSG offer for unlimited events) $

a. Softball $

b. Track and field $ 5 Site event fees are additional fees to defray facility and/or officiating costs of specific events. The added cost is $6 per event.

c. Volleyball $

6 I want to be a “Friend of WSG” and make a tax-deductible contribution here $

7 Your Cost for Wisconsin Senior Games 2017 Registration (add lines 4, 5a, 5b, 5c & 6) TOTAL $

Please make checks payable to Wisconsin Senior Games for the total. Send check and all pages of the registration form to:

Wisconsin Senior Games For questions about registration call: Madison Senior Center Reggie Hennessey at 608-274-6842. 330 West Mifflin St Madison, WI 53703

In addition to the event registration cost (above), the following events require on-site fee payment (at the time of competition only. Must be paid in check or cash, no credit cards.) Please do not include these on-site fees with your registration form.

On-Site Fees EVENT # EVENT FEE

1 Skeet/Stoughton Conservation Park $8 2 Trap/Stoughton Conservation Park $8

13, 24,37, 40,44 Bowling/All Locations (fee for each location where participate) $8

39 Golf-9 holes/Monona Golf Course (cart additional)

$14 to $21

17-21

Pickleball/Sun Prairie (one fee for multiple events, i.e. singles, doubles, mixed doubles)

$5

41,42, 47 Tennis/Powless Tennis Center ($5 per Doubles match) $5 (per match)

WAIVER AND RELEASE OF LIABILITY - must be signed by all participants before allowed to compete. By registering/participating, I acknowledge that individual insurance is not provided for Wisconsin Senior Games events and agree to adhere to program rules. I warrant and represent that I am in good physical health and condition, and I am physically able to compete in the events I have selected. I know of no physical restrictions whatsoever which would prevent my participation in these events. I understand that competition is inherently dangerous and I am responsible for my own actions and the security of my private property. I do hereby, for myself, my heirs, executors and administrators, and anyone who may bring a claim on my behalf, waive, release, and forever discharge Wisconsin Senior Games, its officers and directors, agents, officials, volunteers and event sites, from liability for any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in Wisconsin Senior Games. In the event I am injured, I consent to the provision of emergency care. Please note: photos taken during events and competition may be used for educational or marketing purposes by the Wisconsin Senior Games. I hereby pledge that I am 50 years of age or older as of December 31, 2017 and eligible to participate in these games. By signing below, I understand and agree to the "Waiver and Release of Liability." __________________________________ _______________________ Signature Date

Wisconsin Senior Games 2017 Registration Form – Must be post marked by May 19, 2017 Page 1 of 2Please print legibly. Thank you! Updated April see www.wiseniorgames.org for online registration NAME First Name

MI

Last Name

ADDRESS

Street

City

State

Zip Code

CONTACT INFORMATION Home Phone

( ) Work Phone

( )

Emergency Contact Name

Emergency Contact Phone

( ) Email Address

This email address may be used to send you information about the Wisconsin Senior Games activities before, during, and after the games.

Check here if you do not want to receive such emails. ATHLETE INFORMATION

Gender M F

Date of Birth – Month/Day/Year / /

M M D D Y Y Y Y

Age on December 31st 2017

Failure to provide age and DOB info may result in rejection.

Wisconsin Senior Games 2017 Shirt No, I do not want a shirt

Yes, I want a shirt

If, you answered “Yes” for a shirt, circle the size

S M L XL XXL XXXL Bowling Average (if bowling) _________

Team Sports – Fill in only if you are on any of the team sports below* Tennis Doubles

Partner Name*

Pickle ball Doubles

Partner Name*

Softball Captain Name*

Team Name*

Volleyball Captain Name*

Team Name*

Basketball (3 on 3)

Captain Name*

Team Name*

*If you would like to be on a team, and do not have enough participants, please contact the event chairperson for assistance (see pg 3)

EVENT SELECTION – Put an ‘X’ by the event(s) in which you will be participating. Please also mark the same events on your schedule.

1 Skeet 2 Trap 3 Track-50 meter dash 4 Track-100 meter dash 5 Track-200 meter dash 6 Track-800 meter walk 7 Field-Discus Throw 8 Field-Softball Throw 9 Field-Standing Jump 10 Field-Shot Put 11 Field-Turbo Javelin 12 Cards-Cribbage 13 Bowling- Bowl-A-Vard

14 8-Ball Pool 15 Cards-Euchre,

Stoughton 16 Dart Ball 17 Pickleball–Singles(M) 18 Pickleball–Singles(W) 19 Pickleball-Doubles(M) 20 Pickleball-Doubles(W) 21 Pickleball-Mixed

Doubles 22 Table Tennis 23 Cards-Euchre 24 Bowling- Schwoeglers 25 Cards-Euchre

26 Basketball-Free Throw27 Basketball- Hot Shots 28 Basketball-3 Point

Shot 29 Swimming 25m Breast30 Swimming 50m Breast31 Swimming 25m Back 32 Swimming 50m Back 33 Swimming 25m Free 34 Swimming 50m Free 35 Volleyball(M)

36 Volleyball(W) 37 Bowling 38 Softball-slow pitch 39 Golf-9 holes 40 Bowling-Dream Lanes 41 Tennis-Doubles (W) 42 Tennis-Doubles (M) 43 Cards - Euchre 44 Bowling 45 Basketball(3 on 3) 46 Cards-Sheepshead 47 Tennis-Mixed Doubles

Wisconsin Senior Games 2017 Registration Form – Must be post marked by May 19, 2017 Page 2 of 2EVENT REGISTRATION COSTS see www.wiseniorgames.org for online registration The first event is $12 ($10 for cards) and $5 for each additional event. Wisconsin Senior Games Special Offer: Unlimited events for $40.00 (excludes on-site fees). DETERMINE YOUR COST For each item that applies, enter that amount in the subtotal to the right. No. ITEM ACTION REGISTRATION COST/EVENT SUBTOTAL 1 1st Event $12 ($10 for Cards) $

2 Activity Events Additional Events

# of additional Events Multiply by $5 per event $

3 Add the subtotals from lines 1 and 2 $ 4 Enter the lesser of the the total of line 3 or $40 (the WSG offer for unlimited events) $

a. Softball $

b. Track and field $ 5 Site event fees are additional fees to defray facility and/or officiating costs of specific events. The added cost is $6 per event.

c. Volleyball $

6 I want to be a “Friend of WSG” and make a tax-deductible contribution here $

7 Your Cost for Wisconsin Senior Games 2017 Registration (add lines 4, 5a, 5b, 5c & 6) TOTAL $

Please make checks payable to Wisconsin Senior Games for the total. Send check and all pages of the registration form to:

Wisconsin Senior Games For questions about registration call: Madison Senior Center Reggie Hennessey at 608-274-6842. 330 West Mifflin St Madison, WI 53703

In addition to the event registration cost (above), the following events require on-site fee payment (at the time of competition only. Must be paid in check or cash, no credit cards.) Please do not include these on-site fees with your registration form.

On-Site Fees EVENT # EVENT FEE

1 Skeet/Stoughton Conservation Park $8 2 Trap/Stoughton Conservation Park $8

13, 24,37, 40,44 Bowling/All Locations (fee for each location where participate) $8

39 Golf-9 holes/Monona Golf Course (cart additional)

$14 to $21

17-21

Pickleball/Sun Prairie (one fee for multiple events, i.e. singles, doubles, mixed doubles)

$5

41,42, 47 Tennis/Powless Tennis Center ($5 per Doubles match) $5 (per match)

WAIVER AND RELEASE OF LIABILITY - must be signed by all participants before allowed to compete. By registering/participating, I acknowledge that individual insurance is not provided for Wisconsin Senior Games events and agree to adhere to program rules. I warrant and represent that I am in good physical health and condition, and I am physically able to compete in the events I have selected. I know of no physical restrictions whatsoever which would prevent my participation in these events. I understand that competition is inherently dangerous and I am responsible for my own actions and the security of my private property. I do hereby, for myself, my heirs, executors and administrators, and anyone who may bring a claim on my behalf, waive, release, and forever discharge Wisconsin Senior Games, its officers and directors, agents, officials, volunteers and event sites, from liability for any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in Wisconsin Senior Games. In the event I am injured, I consent to the provision of emergency care. Please note: photos taken during events and competition may be used for educational or marketing purposes by the Wisconsin Senior Games. I hereby pledge that I am 50 years of age or older as of December 31, 2017 and eligible to participate in these games. By signing below, I understand and agree to the "Waiver and Release of Liability." __________________________________ _______________________ Signature Date

11 2017 WISCONSIN SENIOR GAMESOn-line registration available

Team Registration Form 2017 Wisconsin Senior Games PLEASE PRINT (Required for Volleyball, Slow Pitch Softball & Basketball)

Name of Team ________________________________________ Team Event __________________________

Team Captain ___________________________ Ph. Home ( ) ____________ Work ( )______________

Team members are responsible to send in their ownregistration form with payment to the Wisconsin SeniorGames. Team captains are responsible to complete thisform listing team members and submit roster with theirindividual participant registration form to:

Softball captains please note new guidelines for registration under Specific Event Guidelines.Team Members (Please Print clearly)Name Phone Age 12-31-16

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

_________________________________________ ________________ _____

If more space is needed, attach a second page. Photocopies of this form are accepted.* Teams will compete in age brackets based on the age (as of December 31st 2017)

of the youngest team member registered above.

Wisconsin Senior GamesMadison Senior Center330 Mifflin StreetMadison, WI 53703

Final Registration Deadline: May 19, 2017

2017 WISCONSIN SENIOR GAMES 12 On-line registration available

Teamwork Makes a Winner!Teamwork is a solid function in the mission of providing a successful yearof Wisconsin Senior Games. With the election of officers to the Board ofDirectors, and the membership of that body, begins the process of workingtogether to establish the policies, procedures, and delivery of the JuneWisconsin Senior Games. However, it involves many more persons toassist in seeing that these items are carried out. We have the websitecoordinator, the printing company and its staff, the advertisers who sup-port us, the different venues, the event chair persons who coordinate withthe President to establish the timing and carryout of the planned activitiesand, last but not least, are the participants who bring it all to fruition asthey work together to make the year a successful event for all.

Seniors showing camaraderieafter a tough softball game.

Volleyball action at PrincetonClub-East, featuring lobs,strikes and precise ballplacement.

13 2017 WISCONSIN SENIOR GAMESOn-line registration available

Reggie Hennessey, President2409 McKenna Blvd., Madison, WI 53711608-274-6842Email: president@wiseniorgames.org

Vice President – vacant

Mike Procknow, Treasurer9059 Ridgeview Road, Mt. Horeb, WI 53572608-437-7610Email: maprocknow@gmail.com

Ann Nord, Secretary4029 Lori Circle, Madison, WI 53714(608) 347-1894Email: amnord@charter.net

Linda Bolles5102 Black Oak Dr.Madison, WI 53711608-577-7693rosebolles@sbcglobal.net

Bill Brophy6860 Park Ridge Dr., Madison, WI 53719608-277-0282Email: bbrof@aol.com

Dennis Dowd729 Ash Ct, Verona, WI 53593608-845-8701Email: dendowd@yahoo.com

Mark Hanson9 Plover Cr.Madison, WI 53717608-239-8332Hanson.mark.ed@gmail.com

Board of Directors for Wisconsin Senior Games 2017

Fernando Hernandez,5831 Lupine Ln #321, Madison, WI 53718(608) 244-6257Email: fernando@ wiseniorgames.org

Emy Imhoff2518 Dahle St., Madison, WI 53704608-244-7133

John Q. A. Smith3834 Johns St., Madison, WI 53714(608) 222-0134

Honorary Members

Bob Frambs1634 Angel Crest Way, Madison, WI 53716(608) 222-9204Email: frambsbob@yahoo.com

Mike Metcalf7117 Maple Point Drive, Madison, WI 53719(608) 320-6155Email: mmetcalf12@charter.net

Jean O’LearyMSCR - East4620 Cottage Grove Road, Madison, WI 53716(608) 709-1928 Email: joleary@madison.k12.wi.us

John Schultz5006 Flambeau Rd., Madison, WI 53705608-231-2309

2017 WISCONSIN SENIOR GAMES 14 On-line registration available

Working on the registration book through the years

2016

2015

2009

Like clockwork, editing committee meets everyyear to prepare the information for the WisconsinSenior Games Registration Book. Various SeniorCenter sites have provided computer support inthe last few years. Thanks to the Madison andFitchburg Senior Centers facilities pictured here.

1/2 Page for Wells Printing1/2 Page for Wells Printing

3121 Watford Way, Madison, WI 53713608.274.7474 • www.printanddigital.com

Serving the Madison Areafor Over 90 Years!

15 2017 WISCONSIN SENIOR GAMESOn-line registration available

We offer morning leagues on

Monday-Wednesday-Thursday

-Friday6285 Nesbitt Rd.

Fitchburg, WI

Www.tenpinalleys.com

We offer daily lunch specials

Open bowling every morning

Kids birthday parties

Private banquets

Give us a call at 845-1010

Check us out on Facebook

2017 WISCONSIN SENIOR GAMES 16 On-line registration available

NOW FORMING YEAR ROUND LEAGUES ON

TUESDAYS WEDNESDAYS

THURSDAYS AND FRIDAYS

We provide Coffee, Donuts,

Danishes, and Muffins

SIGN UP TODAY!

Call 608-244-7246 To Reserve Your Spot

2121 E. Springs Dr. Madison, WI 53704

430 Clarmar Dr. Sun Prairie, WI 53590

© a

dfini

ty

‘‘Theywere

wonderful.’’

(608) 221-5420East Madison/Monona • West Madison/Middleton

Stoughton • Oregon • Cross PlainsFitchburg • Lodi

Conversation, coffee and6000 sq. feet of antiques,collectibles, and retro for

your enjoyment!1922 S. Stoughton RoadMadison, WI 53716608-243-3222

Closed MondayTues.-Fri. 10-6

Sat. 10-5Sun. 11-5

Daily Lunch SpecialsHomemade soupsFriday Fish FryBreakfast Saturdayand Sunday's

5thquarter.biz

161 Horizon DriveSuite 110Verona, WI 53593608-845-9690

1422 MacArthur Rd.

vineryglass.com

Create Your Own Glass Art

Beginners welcome and encouraged.Many inspiring classes to choose from.Fun and friendly environment to explore your crea ve side!

Fused Glass Stained Glass

Mosaic Flameworking

There is More to Successful

Aging Than you Think

330 W Mifflin St Madison, WI 53703

608-266-6581 www.madisonseniorcenter.org

Successful aging can be defined as …

Avoiding Disease & Disability

Engagement with Life

Maintaining High Cognitive and

Physical Function

Bringing you programs and events that promote successful aging:

Aging Mastery Program

Academic Lectures

Art Classes & Exhibits

PLATO

Yoga & Simple Strength

Computers & more!

A

like neighborhoods used to be.NEIGHBORHOODWhere friendships are forged, neighbor helps neighbor, and the community is

bonded together by shared values.

Cottages & Condos • Apartments Assisted Living • Memory Care Neighborhood Main Street with

Café, Greenhouse & Chapel