Bug Chucker Cup - INDIVIDUAL Registration Form

Please proceed with this online form when you are prepared to pay the $50 individual registration fee  using your credit card, bank card or PayPal account.

If you are not prepared to pay for this today, please do not proceed. A copy of this registration will be mailed to your provided email address for your records. Please take a moment to review and ensure the information you enter is correct.

If you and a teammate are registering individually online as part of a team, please include your partner's name in the space provided below.

If you prefer to register manually and pay by cheque, click here.

<form-template> <fields> <field type="text" subtype="text" required="true" label="Name" class="form-control text-input" name="text-1564752833585"></field> <field type="text" subtype="text" required="true" label="Address" class="form-control text-input" name="text-1564752611867"></field> <field type="text" subtype="text" label="Text Field" class="form-control text-input" name="text-1564752676126"></field> <field type="text" subtype="text" label="Text Field" class="form-control text-input" name="text-1564752712927"></field> <field type="text" subtype="text" required="true" label="City" class="form-control text-input" name="text-1564752620402"></field> <field type="text" subtype="text" required="true" label="Province" class="form-control text-input" name="text-1564752631147"></field> <field type="text" subtype="text" required="true" label="Postal Code" class="form-control text-input" name="text-1564752645654"></field> <field type="text" subtype="text" required="true" label="Phone" class="form-control text-input" name="text-1564752658332"></field> <field type="text" subtype="email" required="true" label=" Email - please use the email related to your payment" class="form-control text-input" name="text-1564752679342"></field> <field type="text" subtype="email" required="true" label="Email - please re-enter your email" class="form-control text-input" name="text-1564752721591"></field> <field type="text" subtype="text" label="Additional Information / If registering as part of a team, please enter your partner's name" class="form-control text-input" name="text-1564752748364"></field> <field type="paragraph" subtype="p" label="TERMS * You acknowledge and agree to abide by the tournament rules, AND release all event organizing officials and associates from any and all liability of injury or loss occurring during the event, AND give permission to the Bug Chucker Cup and its affiliates the use of your name and of photos taken of you durring the event for promotional use. REFUND POLICY * - 100% refund: (31+ days before event) - 0% refund: (30 days or less before event). Please take a moment to review and ensure the information you enter is correct before submitting. You cannot proceed without checking the box to accept the Terms &amp;amp; Refund Policy." class="paragraph"></field> <field type="checkbox" required="true" label="I accept the Terms &amp;amp; Refund Policy" class="checkbox" name="checkbox-1564753125516"></field> </fields> </form-template>

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