SUPER GROM SURF FESTIVAL
Print and fill out form.
Mail to: FSA - 124 5th Avenue North, Jacksonville Beach, FL 32250 or you may fax
to: (904) 247-5677 or you may scan and email to: fsa@floridasurfing.org
This event will be held at the Jacksonville Beach Pier. From 10 AM - 4 PM.
Please bring sunscreen, towel, water and lunch if you like. Free parking is available at the Pier or across the street.
We will post additional information here on the site so check back often.
CIRCLE ONE: (If you want to sign up for both contest then fill out two seperate
entry forms please)
JUNE 27
JULY 25
Please Print Carefully.
Name: ____________________________________________________
Phone: ( ____) _________________________________
Email: ________________________________________
Address: ___________________________________________
City: _____________________________
State: ______________
Zip: _____________________
Email: Age as of January 1, 2009 ______________________
Birthdate: ____________________________
In consideration of acceptance of my application to the Super Grom Surf
Festival, I hereby release the City of Atlantic Beach, the State of Florida, the Florida Surfing Association, all sponsors, agents, successors, and assigns any other person or organizations offi cially connected
with their competition from liability for and all injuries or damages whatsoever arising
from my participation or presence at their event. I also give my release for the use of photos, fi lm or video taken of me
at the event. I fully understand that I will be disqualified from the competition
if I am found guilty of any rules violation, with no refund of entry fees. In addition, I am responsible for keeping posted
of any changes in the scheduled times.
Contestant Signature _______________________________________
Parent/Guardian Signature ___________________________________
Date: ___________________
