Event Registration Registrations must be submitted 2-weeks in advance to avoid a $20 late fee. Applicant InformationNAME* First Last MAILING ADDRESS* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PHONE*EMAIL* Are you a member of PSIA-AASI?*YesNoPSIA-AASI Member ID Number*Name of other Professional Organization Affiliation*Event InformationEmail firstname.lastname@example.org if you have questions.Event*Discipline*AlpineSnowboardChildren'sSeniorAdaptiveTelemarkCross CountryFreestyleLocation*Start Date* End Date* Are you PSIA-AASI Education Staff and/or Event Staff?*YesNoWere you invited to attend this event at no cost?*YesNoDo you want to register for a second event using this same form?*YesNo**************************2nd Event**************************Event*Discipline*AlpineSnowboardChildren'sSeniorAdaptiveTelemarkCross CountryFreestyleLocation*Start Date* End Date* Are you PSIA-AASI Education Staff and/or Event Staff?*YesNoWere you invited to attend this event at no cost?*YesNoDo you want to register for a third event using this same form?*YesNo**************************3rd Event**************************Event*Discipline*AlpineSnowboardChildren'sSeniorAdaptiveTelemarkCross CountryFreestyleLocation*Start Date* End Date* Are you PSIA-AASI Education Staff and/or Event Staff?*YesNoWere you invited to attend this event at no cost?*YesNoAdditional InformationAre you using a credit on account? Are you only signing up for 1 day of a multi-day event? Let us know...Event FeesYou will receive a Paypal invoice via email for the event fees. Your registration is not complete until you complete your payment.Administrative Fees and PoliciesWestern Division Event Cancellation Policy *For cancellations at least 2-weeks in advance of the event: A full refund will be provided. *For cancellations at least 1-week in advance of the event: There is a minimum $10 fee, and the remaining balance of the registration fees will be refunded. *For cancellations at least 2 working days in advance of the event: There is a minimum $10 fee to cancel, and 50% of the remaining registration fees will be refunded. *For cancellations less than 2 working days in advance of the event: No refunds will be issued. **Western Division reserves the right to cancel any event if it lacks registration by the published date. All fees will be refunded. RETURED CHECKS/DECLINED CHARGES: Retumed checks will NOT be re-deposited and a $25 fee will be assessed. All returned checks or declined charges must be re-paid 2 business days prior to the event or registration will be cancelled. WaiverI am voluntarily participating in a Ski/Snowboard Event (hereinafter “Event”) held by the Professional Ski Instructors of American-Western Division, also doing business as American Association of Snowboard Instructors-Western Division (hereinafter “PSIA/AASIW”). In consideration for being permitted to participate in the Event, I, for myself, my heirs, executors, administrators, and assigns, waive and release any and all rights and claims including any claim of negligence I may have or accrue against PSIA/AASI-W, and any other sponsors or co-sponsors, or their officers, representatives, agents, employees, successors and assigns (hereinafter collectively the “Released Parties”) for any and all liability, claims, demands or causes of action that I may hereafter have for injuries, damages or death that I may suffer as a result of my participation in the Event, including the use of equipment provided to me and use of facilities. I am an experienced skier/snowboarder and instructor and am aware of the risks of snowsports and risks of participating in PSIA/AASI-W events and training including, but not limited to, use of equipment in a manner not intended by the manufacturer and body movements not intended for the general public. I understand and acknowledge that involvement in the Event and all potential activities associated therewith have inherent risks as well as risks that may be created or increased by actions or negligence of others and I EXPRESSLY AND VOLUNTARILY ASSUME ALL RISK OF DEATH OR PERSONAL INJURY SUSTAINED WHILE PARTICIPATING IN THE EVENT WHETHER OR NOT CAUSED BY THE NEGLIGENCE OF THE RELEASED PARTIES. I agree to INDEMNITY AND HOLD THE RELEASED PARTIES HARMLESS from all claims, judgments, and costs, including attorney’s fees, incurred in connection with any action brought as a result of my participation in the Event. I will take full responsibility for, and hold harmless the Released Parties from any injury that I may suffer or inflict upon others or their property as a result of my participating in the Event. I further represent that I am at least 18 years old, or that as the parent or (adult) legal guardian, I waive and release any and all legal rights that may accrue to me, to my minor child or the minor child for whom I am (adult) legal guardian, as the result of any injury that my minor child, the minor child for whom I am (adult) legal guardian or I may suffer while engaging in the Event and all activities associated with the Event. I hereby acknowledge that this Release of Liability, Waiver of Legal Rights and Assumption of Risk is a contract pursuant to which I have released any and all claims against the Released Parties resulting from participating in the Event including any claims of negligence of the Released Parties. Media Release* I agree that my participation in the Event includes having my image photographed, videographed and published and authorize PSIA/AASI-W to take and publish such images for use in PSIA/AASI-W print, online and video-based marketing materials as well as any other PSIA/AASI-W publications. I agree that taking and publication of my image does not confer in me any right of ownership, right to royalties or right to any form of financial compensation. Waiver Release of Liability & Cancellation Policy* I have read this Waiver and Release of Liability and the Refund and Cancellation Policy and Agree to it’s terms. Signature/Release*I DECLARE: I AM AN EXPERIENCED SKIER/SNOWBOARDER AND INSTRUCTOR, l WISH TO PARTICIPATE IN THIS EVENT. lN CONSIDERATION OF ACCEPTANCE TO AND PARTICIPATION IN THIS EVENT, I HEREBY WAVE, RELEASE AND FOREVER DISCHARGE THE SKI AREA, PSIA·W, EXAMINERS. EMPLOYEES. AGENTS, MEMBERS, SPONSORS AND ALL OTHER PERSONS CONNECTED WITH THIS EVENT FROM ANY AND ALL LIABILITY FOR INJURY, DAMAGE OR DEATH, CAUSED BY THE NEGLIGENCE OR OTHER UNINTENTlONAL CONDUCT. l AM AWARE OF THE RISKS OF SKllNG/SNOWBOARDING, INCLUDING SERIOUS INJURY AND DEATH. I AGREE TO ASSUME ALL RISKS AND TO RELEASE ALL PERSONS ABOVE FROM ANY LIABILITY FOR NEGLIGENCE OR OTHERWISE ACTIONABLE CONDUCT.I HAVE FULLY READ AND VOLUNTARILY AGREE TO THE ABOVE TERMS AND CONDITIONSNameThis field is for validation purposes and should be left unchanged.