APPLICATION FOR ENTRY (Please read the schedule thoroughly before filling in this entry form and signing the acknowledgement below)
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1 Royal Agricultural Society of WA WOOD CHOPPING APPLICATION FOR ENTRY (Please read the schedule thoroughly before filling in this entry form and signing the acknowledgement below) Entries close 5.00pm FRIDAY 30 JUNE ENTRIES RECEIVED AFTER THIS TIME AND DATE WILL NOT BE ACCEPTED. Exhibitors are requested to forward their entry forms to: Wood Chopping Coordinator, PO Box 135, Claremont WA 6910 PERSONAL DETAILS Exhibitor Name: (This will be printed in the Catalogue and Prize Certificates) Contact Name: Mr, Mrs, Ms, Miss... First Name: Surname: Postal Address: Suburb: State: Postcode: Telephone:...Fax:... Mobile: PAYMENT OF ENTRY FEES Method of Payment for Entry fees: Cheque for $... to be made payable to the Royal Agricultural Society of WA. (Office use only - cheque number ) Please debit my Mastercard Visa for the amount of $... Card Number: / / / Expiry Date: / Name on Card:...Signature... CONDITIONS OF ENTRY 1. I/We certify that the particulars as shown on this entry form are correct and I have read and agreed to the terms and conditions of entry as detailed in the 2017 Wood Chopping Schedule, including the liability and indemnity provisions. 2. I/We agree to be bound by the Society s General Show Regulations (refer to the RASWA website or alternatively a copy is available upon request). 3. Permission is hereby granted to the publication of photographs relating to participation in the Competition. SIGNATURE OF EXHIBITOR:... DATE: / / PRIVACY ACT STATEMENT The information provided by the Exhibitor in the application for entry is collected and used by the Royal Agricultural Society of Western Australia (RASWA) to organise and conduct Competitions at the 2017 IGA Perth Royal Show. We may publish details such as your name, address and exhibit details in any RASWA publication or communication. Such information may also be made available to, and published by, the media. We will not disclose your information without your consent for any other purpose unless required or authorised by law. You may request access to your personal information and, if necessary, request that our records of that information be corrected by writing to the Chief Executive Officer at the Royal Agricultural Society of Western Australia, PO Box 135, Claremont WA PAGE 1 OF 5
2 ACCOUNT DETAILS RASWA has a policy whereby all prize money is paid by EFT (Electronic Funds Transfer). Your banking details will be kept secure and can only be used by RASWA to credit your bank account. Please complete your account details even if you have provided them previously. In accordance with the rules of the competition, failure to provide your bank details will mean that any prize money you earn will be forfeited and retained by RASWA. Please complete the following: Account Name. Print clearly the account name as shown on your account records. Do not write the account type (for example savings, cheque or mortgage offset). Include spaces between each word and between initials in the account name. Bank. This is the bank name (for example NAB, ANZ, Commonwealth Bank, etc). BSB No. This six digit number identifies the financial institution. Do not include spaces, dashes or hyphens in the number. Account No. You cannot use an account number with more than nine characters. Do not include spaces in the account number. Prize money cannot be paid via electronic funds transfer (EFT) if the nominated account has restrictions on EFT deposits, is a credit card, or an overseas account. THIS SECTION MUST BE COMPLETED. ACCOUNT NAME: Royal Agricultural Society of WA PRIZE MONEY PAYMENT DETAILS BANK: BSB NO: ACCOUNT NO: GST MANAGEMENT RASWA requires the following information from all Competitors in order to make appropriate payments to those Competitors who win a prize. 1. Is what you are supplying to RASWA done as a private recreational pursuit or hobby? Y N 2. If No to Question 1, what is your ABN? 3. Are you registered for GST? Y N NOTE: It is a condition of entry that this information be forwarded to the Royal Agricultural Society of WA. If you do not complete this section of the form we may be required to withhold 46.5% of your prize payment. Office Use Only Account Details Entered: Date: / / Please tick Please tick
3 Royal Agricultural Society of WA WOOD CHOPPING P Class No. Event $ SINGLET SIZE: 1 300mm TREE PEGGING WORLD CHAMPIONSHIP mm AUSTRALIAN TREE PEGGING CHAMPIONSHIP mm AUSTRALIAN CHAMPIONSHIP S/B mm AUSTRALIAN CHAMPIONSHIP U/H mm S/B CHAMPIONSHIP mm U/H CHAMPIONSHIP mm WESTERN AUSTRALIAN CHAMPIONSHIP U/H (WA ONLY) mm WESTERN AUSTRALIAN S/B CHAMPIONSHIP (WA ONLY) mm U/H mm OPEN HANDICAP U/H mm OPEN HANDICAP U/H mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm U/H AND S/B COMBINATION mm 3RD DIVISION S/B mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm TREE PEGGING mm TREE PEGGING mm TREE PEGGING mm S/B mm S/B mm S/B mm S/B mm 1ST DIVISION S/B mm 3RD DIVISION S/B mm 1ST DIVISION S/B mm 2ND DIVISON S/B mm 1ST DIVISION S/B mm 2ND DIVISION S/B mm 1ST DIVISION S/B HARD HITTING mm 2ND DIVISION U/H mm U/H 250mm S/B PAIRS EVENT FOUR MAN RELAY, 1 X 275mm U/H, 1 X 250mm S/B AND 1 X 2 MAN BUTCHERS BLOCK mm S/B - NOVICE mm U/H - NOVICE mm U/H - NOVICE mm JUNIOR U/H ROUND ROBIN (Under 18 years) mm JUNIOR U/H ROUND ROBIN (Under 16 years) mm VETERANS S/B (55 years and over) mm VETERANS S/B (55 years and over) mm VETERANS S/B ROUND ROBIN (65 years and over) mm D/H SAWING CHAMPIONSHIP (Open to all sawyer and type of saws) mm D/H SAWING HANDICAP mm S/H SAWING CHAMPIONSHIP (Open to all sawyer and type of saws) mm S/H SAWING HANDICAP (Open to all sawyer and type of saws) mm U/H, 250mm S/B, FATHER AND SON WA VERSUS VETERANS. BEST OF 3 SERIES WA VERSUS NZ. BEST OF 3 SERIES Tick in box below for size required. Right OR Left Handed R L (Please tick) (Transfer this amount to the payment of entry fees on front page) $ 14 (90cm) 16 (95cm) 18 (100cm) 20 (105cm) 22 (110cm) 24 (115cm) 26 (120cm) 28 (125cm) PAGE 3 OF 5
4 Royal Agricultural Society of Western Australia 2017 IGA PERTH ROYAL SHOW - WOOD CHOPPING DISCLAIMER STATEMENT Before signing this Disclaimer, refer to the Section Conditions and General Regulation 17 in the Society s Wood Chopping Schedule ALL ADULT COMPETITORS/PARTICIPANTS 18 YEARS OF AGE and OVER I acknowledge and agree as a condition of participating at the 2017 IGA Perth Royal Show that neither the Royal Agricultural Society of Western Australia, its directors, officers, employees, members and agents, participants, officials, volunteers, medical personnel, any persons, promoters, sponsors, providers of equipment, advertisers, nor owners or lessees of premises used to conduct the EVENT(S) shall be under any liability whatsoever for either the death of or for any injury, loss or damage which may be sustained or any claim, demand, suit or costs arising there from and incurred by myself or any attendant or any other competitor/participant for whom I am responsible, as a result of participation in or being present at the EVENT(S). I acknowledge that wood chopping activities are dangerous and that accidents causing death, injury, disability and property damage, can, and do occur. I unconditionally accept responsibility to safeguard myself and any attendant and any other competitor/ participant for whom I am responsible. By signing hereunder I confirm I have read and understood the contents of this Disclaimer together with the Society s Section Conditions and General Show Regulation 17, by which I agree to abide. Name (Print): Signature: Dated this: day of 2017 PARENT/GUARDIAN CONSENT for COMPETITORS/PARTICIPANTS UNDER 18 YEARS OF AGE I,, being the parent/guardian of Name: Address: Date of Birth: confirm that I have read the whole of this document and have taken all necessary actions to ensure I am aware of the activity in which the above named competitor/ participant will participate at the 2017 IGA Perth Royal Show and consent to him/her participating. In doing so, I acknowledge that wood chopping activities are dangerous and that accidents causing death, injury, disability and property damage, can, and do occur. I unconditionally accept responsibility to safeguard the above named competitor/participant for whom I am responsible. I acknowledge and agree that neither the Royal Agricultural Society of Western Australia, its directors, officers, employees, members and agents, participants, officials, volunteers, medical personnel, any persons, promoters, sponsors, providers of equipment, advertisers nor owners or lessees of premises used to conduct the EVENT(S) shall be under any liability whatsoever for either the death of or for any injury, loss or damage which may be sustained or any claim, demand, suit or costs arising there from and incurred by the above named competitor/participant or by any other person for whom I am responsible as a result of participation in or being present at the EVENT(S). By signing hereunder I confirm I have read and understood the contents of this Disclaimer together with the Society s Section Conditions and General Show Regulation 17 by which I agree to abide. Name (Print): Signature: Dated this: day of 2017 PAGE 4 OF 5
5 WOOD CUTTING PERFORMANCES The undermentioned are my last six performances for each type of event. STANDING BLOCK Date Town & State Size of Log My Back Mans Name & UNDERHAND Date Town & State Size of Log My Back Mans Name & TREE FELLING PERFORMANCES Date Town & State Size of Log My Back Mans Name & PAGE 5 OF 5
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