TEAM ROSTER (MUST BE COMPLETED) (Please be sure to fill in all required information or the form will be returned)

NAME ADDRESS CITY STATE ZIP

30th ANNUAL MUD VOLLEYBALL TOURNAMENT TEAM REGISTRATION & ENTRY FORM

TEAM NAME we reserve the right to request a name change

TEAM CAPTAIN ADDRESS CITY STATE ZIP PHONE (DAY) (NIGHT) EMAIL $ AMOUNT ENCLOSED Make checks payable to: Epilepsy Foundation of CT

A $5.00 fee will be added to all credit

card transactions

Yes, We would like to register for the Corporate Package!! ($600 per team by 8/05/2016)

Name on Banner: _____________________________ ____________________________________________ Name on Back of T-Shirt: _______________________ ____________________________________________

To enter the tournament, please complete the entry form below and return it with your check for $250.00 Before July 11th; $275.00 after July 11th. It is $325.00 on the day of the event. Mail Completed Forms to: The Epilepsy Foundation of Connecticut, Inc. - 386 Main Street - Middletown, Connecticut 06457- 3360

We hereby agree to indemnify, and hold harmless the Epilepsy Foundation of Connecticut, Inc., Connoisseur Media LLC d/b/a 102.9 The Whale WDRC-FM, 99.1 WPLR-FM, 95.9 The Fox WFOX-FM, Talk of Connecticut 1360 WDRC-AM, 1470 WMMW-AM, 1240 WWCO-AM and 610 WSNG-AM, the Town of Middletown, and other sponsors from and against any and all liability claims of liability, causes of action, expenses (including attorney’s fees), and loss or damage whatsoever relating to the Mud Volleyball Tournament taking place August 20, 2016, regardless of whether any such injury to or death of persons or damages or destruction of property is due or claimed due to any negligence or fault of the aforesaid parties, their directors, officers, employees, agents or invitees. We hereby consent to the use of any photographs or videos taken by the Epilepsy Foundation of Connecticut, Connoisseur Media LLC d/b/a 102.9 The Whale WDRC-FM, 99.1 WPLR-FM, 95.9 The Fox WFOX-FM, Talk of Connecticut 1360 WDRC-AM, 1470 WMMW-AM, 1240 WWCO-AM and 610 WSNG-AM , and other sponsors on the day of the event in its promotional or fundraising materials, or for use on their websites.

How did you hear about Mud Volleyball?

Radio Facebook Played Before Friend EFCT Website

The first 25 teams that raise $125 or more (Our team fundraising page, company and personal checks) beyond the entry fee will receive

10 FREE COMMEMORATIVE MVT T-SHIRTS

T H A N K Y O U ! ! !

DeRita Construction

Company, Inc.

T H A N K Y O U ! ! !

WINNING TEAM WILL RECEIVE:

Indian Hill Tree Farm

City of Middletown Hunters Ambulance

Grace Lutheran Church - Troop 41 Scouts

South District Fire Department Durham Fire Department

Middletown Park & Rec. Dept. Connecticut Agricultural

Experimental Station Middletown Water & Sewer Dept.

Trophies T– Shirts Reserved Parking (‘17 Tournament) with private port-o-let Fee Waived for 2017 Year of Bragging Rights of Course! Other prizes

FROM HARTFORD take 91 South: or

FROM NEW HAVEN take 91 North: or

FROM WATERBURY take 84 East to

691 East to 91 North: to Route 9 South.

Take Exit 11 (Randolph Road). Take a left at the end of the exit.

Zoars Pond is 1¾ mile on the right.

Captains packet and all MVT info can be found at www.mudvolleyballct.com

Registrations must be received in our office by

4:00 pm on August 19 No exceptions!

Office will be closed.

Registration will begin at 7:30 a.m. Games begin at 8:30. Please ensure your entire team arrives on time!! Maximum number of teams - 240

Food vendor on site. Tournament will be held Rain or Shine.

No Refunds After Aug. 1, 2016. Minimum age for players is 18 years.

Parking Donation - $3 NO DOGS ALLOWED! - NO GRILLS ALLOWED!

DIRECTIONS TO ZOARS POND

INFORMATION

NO ALCOHOL ALLOWED PER ORDER OF

THE MIDDLETOWN POLICE DEPARTMENT

For rules, tournament schedule and other

information visit us at www.mudvolleyballct.com

and on Facebook

Mud Volleyball CT call the

Epilepsy Foundation of Connecticut at

860.346.1924 or email efct@sbcglobal.net

for more information.

This year’s event will be kicked

off by

For rules, tournament schedule and other information visit us at www.mudvolleyballct.com and on Facebook - Mud Volleyball CT

call the Epilepsy Foundation of Connecticut at 800.899.3745

This year, we are highly encouraging each team to raise additional money for MVT. All proceeds raised at MVT support the Epilepsy Foundation of Connecticut’s programs and services.

Think about this…...

If 200 teams raise $500 each, EFCT will receive $100,000!

It’s easy…..10 people on a team each raise $50 = $500

Ask 1 friend to donate $50

Ask 2 friends to donate $25

Ask 5 friends to donate $10

The first 25 teams that raise $125 or more (Your team fundraising page, company and personal checks) beyond the entry fee will receive 10 FREE COMMEMORATIVE MVT T-SHIRTS (may NOT be available day of event) Top Fundraising Team The team that raises the most money over $1,000 will receive a free team registration for 2017 tournament.

TEAM FUNDRAISING

Here’s how it works! The team captain will receive an email after your registration

form is sent to EFCT. The email will include a link to your team page. If you want to participate email us a photo, a blurb about your

team and your fundraising goal. Email the link to your MVT teammates asking them to email it to

their friends, family and co-workers asking for donations. You can collect donations online or in person To be eligible for the Top Fundraising Team Prize, you must register a team and turn in your donations by August 21, 2015.

****Don’t forget….Ask if the company you work for has a Matching Gift Program!****

$600.00 per team

Have your company sponsor your team, and get some cool stuff!

Company name on back of t-shirts sold at tournament Team Registration Banner with company Name 10 Mud Volleyball T-Shirts Team Photo (8”x10”) Deadline: 08/05/2016

MVT CORPORATE PACKAGE

DATE & TIME

REGISTRATION 7:30 AM

PLACE

It’s Good Clean Fun!!!

Please co

ntact u

s with

add

ress chan

ges

efct@sb

cglo

bal.n

et.

SATURDAY, AUGUST 20th, 2016

Games start at - 8:30AM

ZOAR’S POND

RANDOLPH ROAD, MIDDLETOWN, CONNECTICUT

$250.00 PER TEAM

AFTER JULY 11th, 2016 - $275.00 PER TEAM

DAY OF EVENT - $325.00 PER TEAM

A $5.00 fee will be added to all credit card transactions

The 30th

Annual Mud

Volleyball

Tournament