2022 Inland Empire Senior Application Deadline: September 16, 2022 Male_____ Female_____
Male or Female (Circle One) D.O.B___________ Age (As of 12/31/22): ______ T - Shirt Size:_______ Last Name:_____________________________ First Name:______________________________________ Address: _______________________________________ City, State, Zip:_________________________ Telephone: ( ) ________________________ Emergency Contact:________________________________ Email Address:___________________________________________________________________________
I will attend the following events: PACKET PICK UP _____ Friday, September 23rd
CLOSING CEREMONIES _____ Friday, October 7th
2.0 - 2.5 or 3.0 - 3.5 or 4.0 - 4.5
PICKLEBALL
Skill Level:
Circle one
Doubles Women ’ s ____ (Fee) $10 Partner ’ s Name:________________________________________ Age _____ Mixed Doubles ____ (Fee) $10 Partner ’ s Name:________________________________________ Age _____ Men ’ s ____ (Fee) $10 or Doubles Women ’ s ____ (Fee) $10 Partner ’ s Name:________________________________________ Age _____ Mixed Doubles ____ (Fee) $10 Partner ’ s Name:________________________________________ Age _____ Men ’ s ____ (Fee) $10 or
TENNIS
(Team Form) Men ’ s ____ (Fee) $150 Co - Ed ____ (Fee) $150 (each member must submit an individual application & entry fee)
SOFTBALL
Singles Doubles
Men ’ s ____(Fee) $10 Men ’ s ____(Fee) $10
or or
Women ’ s ____(Fee) $10 Women ’ s ____(Fee) $10
CORNHOLE
Partner ’ s Name:_______________________________ Age _____ Mixed Doubles ____ (Fee) $10 Partner ’ s Name:_______________________________ Age_____
$10 per person / per event (choose as many events as you would like)
SWIMMING ____400m Free ____50m Fly ____50m Free
____200m IM ____200m Back ____50m Back
____100 IM ____100m Fly ____100m Back
____50m Breast ____100m Free ____100m Breast
(Events are held in order from left to right)
____ 5k ($10) ____10k ($10)
____ 5k ($10) ____10k ($8) 10
WALK
RUN
____ Doubles (Fee) $10 Partner ’ s Name:__________________________ Age _____
BILLIARDS
____$50 (OPEN TOURNAMENT) (REGISTRATION FEE INCLUDED)
GOLF
Singles
Men ’ s ____(Fee) $10
or
Women ’ s ____(Fee) $10
BOWLING
Doubles
Men ’ s ____(Fee) $10
or Women ’ s ____(Fee) $10 Partner ’ s Name:_______________________________ Age _____
Mixed Doubles
Partner ’ s Name:_______________________________ Age_________ (Fee) $10
7
(Each participant must fill out a separate application)
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