NENSA EVENT SANCTION FORM

This form is for all events or activities that ARE NOT Eastern Cups or Championship events

Organizer Information

Club/Organization: __________________________________________________________________________

Race Director: ______________________________________________________________________________

Address: _ __________________________________________________________________________________

Town: __________________________________ State: _____________ Zip: _______________

Phone: _____________________ Fax: ______________________ Email: __________________________

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Race Information

The following is a sample event listing. Make sure that you include all pertinent information.

2/5/08, Prospect Classic Clipper; Prospect Mountain Ski Area, Rte 9, Woodford VT

Event Info: Classic, JI-Master Men 15K Wave Start 11:00AM. JI-Master Women 10K Wave Start 12:30PM

Registration: $20 Received by 2/1, $30 Received after 2/1 Checks to: Prospect Mountain Ski Club

Phone:(802)442-9124 (evening) (802)442-5414(daytime) Mail to: Nancy Steffen, 10 Margaret Lane, Bennington VT 05201

Date: _________________ Event Title:_____________________________________________________

(for administration use, circle applicable) EC, NEMarathon, JOQ, J2Q, Zak, Club

Location:______________________________________________________________________________

Race/Event Format Information: Technique, Classes -Gender-Distance, Start Format, Start time.

___________________________________________________________________________

___________________________________________________________________________

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BKL Event:___________________________________________________________________

Registration Information:

Entry Fee and Deadline Dates:_________________________________________________________________

Checks Payable To/Online Registration Info:_______________________________________________________

Race Contact Name: _________________________________________________________________________

Mailing Address:____________________________________________________________________________

Phone: _______________________ Fax: ____________________ E-Mail/Web site: _______________________ * To review a draft of your race entry, prior to publication in the Competition Guide and on the web site, please circle how you would like to receive it: Fax Email.

Please attach your check for $25 (if not a registered NENSA club)

&

Filled out request for a proof of insurance if needed (download .pdf ] MS Word)

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Insurance Information:

Day of race liability insurance is available through NENSA to race organizers. Please indicate here whether your organization would like to make use of NENSA race day insurance (A NENSA representative will contact you for details). ( YES / NO )

Or, if your organization is otherwise covered, please attach a certificate of insurance for our records.

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Fee Information

• A $25 listing fee is due to NENSA with this form (fee waived for registered NENSA clubs)
• For events with entry fees of $10 or less, and all youth/BKL-only events no user fee/head taxes.
• For events with entry fees of $11 to $15 the participant user fee (aka “head tax”) is $1 per participant.
• For events with entry fees of $16 or more the participant user fee (aka “head tax”) is $2 per participant.

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Return to this form to NENSA:

NENSA, 49 Pineland Dr, Suite 301A, New Gloucester, ME 04260

Or if you have questions contact the Administrative Office

info@nensa.net (p) 207-688-6503 (fax) 207-688-6505