Royal Palm DanceSport Championships – National Qualifying Event (NQE)

Adult & Senior Amateur Couples and Same Sex Couples:

Please complete all information marked "(required)" below, Click to Accept the Terms & Release, and type the full names of both partners (separated by a comma) in the Signature Blank at the bottom. Then click the red "Send" button at the bottom to submit this Form.

You will immediately receive an e-mail with registration instructions and a link to our O2cm Online Registration Form, where you can complete your Competitor Registration and pay your Competitor Fees by PayPal or Credit Card.

Gentleman/ Leader:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):

Gentleman/ Leader's USA Dance (or Affiliated Organization) Membership Number & Expiration Date

USA Dance Chapter of which Gentleman/ Leader is a member (if applicable):

Lady/ Follower:

Name (required)

Email (required)

Telephone Number (required)

Address (all lines required):

Lady/ Follower's USA Dance (or Affiliated Organization) Membership Number & Expiration Date

USA Dance Chapter of which Lady/ Follower is a member (if applicable):

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Terms & Release Form (required of all Competitors):
Please read and and check the box to Accept the following Terms & Release Form (required of all Competitors), and then Type both of your names (separated by a comma) in the Signature Blank below, and Click "SEND" below to submit your Competitor Information & Release Form.

- Check the Box to Accept the Terms & Release (required). By submitting this Competitor Information & Release Form and/or by registering for the Royal Palm Dancesport Competition, each Competitor identified above hereby represents, warrants, and agrees as follows:

1. Payment of Competitor Entry Fees Due. I agree that upon completing the Entries portion of the online Competitor Registration form on O2cm, I/ we will complete Steps 5 and 6 of the O2cm form to add the applicable Competitor Package due for each dancer in our couple, and immediately use the "Pay Now" button found at the bottom of the O2cm Registration Form to pay in full the Competitor Package fees and any Entry Fees applicable for our entries via PayPal or Credit Card. I/ we understand that our Registration is not complete until the Competition Organizer receives full payment of our Competitor Package fees & Entry Fees, as well as our Registration Form.

2. Waiver & Release Accepted and Agreed: I have read, understand and agree to abide by the USA Dance DanceSport Rulebook, as and to the extent applied at the Royal Palm Dancesport Competition (the "Competition"), and the Rules, Regulations and Guidelines for this Competition, as set forth on www.RoyalPalmDancesport.org. I represent and warrant that I am eligible to enter all events for which my partner and I register and that we will not register for an event below our minimum proficiency level in each category or above our maximum Age Category. I understand athletes may be subject to drug testing by the WDSF or USA Dance, and if I am an Amateur Athlete Member of USA Dance, I understand that if I violate the Dancesport Rules of USA Dance, as applied at this Competition, my Amateur Athlete competitor status with USA Dance may be suspended. I understand the Competition may be filmed/videoed/photographed and I agree that the organizers may use any images or videos captured of me at the Competition, and/or my name, for promotional or other purposes related to the Competition, now or in the future. I consent to receiving e-mails or communications from the organizers, now or in the future (from which I may unsubscribe after the Competition, if I so choose). I understand and agree that no responsibility for bodily injury or for loss or theft of articles left in the changing rooms, Competition venue, practice room, seating areas or elsewhere by persons attending or participating in this event, can or will be accepted by the organizers, USA Dance, Inc., the Royal Palm Chapter of USA Dance, Goldcoast Ballroom, any of their respective officers, directors, agents or representatives, or any hotel, and I hereby release, hold harmless, and agree to indemnify all of the foregoing persons & entities from any and all claims or liabilities of any kind arising in connection with my/ our participation in or attendance at the Competition. I understand and agree that everyone attending the Competition does so at his or her own risk.

Please be sure you have filled in all blanks above marked "(required)" and have checked the box to accept the Terms & Release, or this Form will not submit.

To Submit Your Competitor Information & Release Form and Register for the Competition:

Step 1:   Type the full names of both Competitors submitting this Form (separated by a comma) in the Signature Blank below, and Click the Red "SEND" button to Submit this Form. You should then see a message outlined in green on your screen below, saying, "Your Competitor Information & Release Form was submitted successfully."

Step 2:   Watch your E-mail. You will receive an e-mail with instructions and a link to our O2cm online Registration Form, where you can Register for the Competition, as a couple, and pay your Competitor Package and Entry Fees. Your Registration will not be complete until we receive both your Registration Form and your payment in full. (If you have already registered for the Competition, you can ignore the e-mail you will receive. As soon as you have paid in full, you are done.)

Signatures: (required - this form will not submit without typed in signatures)