Name of Team Captain (or individual if entering Individual Division):
Address:
City:
State:
Phone:
E-mail:
Zip:
Division:
All credit card payments are received on line through Pay Pal, a reputable and secure payment center. No entity or individual is given access to your credit card  information other than Pay Pal  - not even Energy2Action.  Please note that you will be charged $1 for processing through PayPal.  
PUZZLE PALOOZA
Saturday, November 12, 2022
Jigsaw Puzzle Tournament
8:00 a.m.- 10:00 a.m. Individuals 
10:00 a.m. - 12:00 p.m. Partners 
12:00 p.m. - 2:00 p.m. 3 Person Teams 
2:00 p.m. - 4:00 p.m. 4 Person Teams - 500 piece
4:00 p.m. - ?? p.m. 4 Person Teams -1000 piece 

Location:  Shelby Senior Services
2120 Intelliplex Dr.
(YMCA Building)
Shelbyville, IN  46176


REGISTER EARLY - WE HAVE 10 TABLES AVAILABLE IN EACH DIVISION
Want a mail-in Registration Instead?
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In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville, The Intelliplex Park,  Energy2Action, LLC, YMCA, and Shelby Senior Services,  for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event.  I understand and acknowledge that participating in this event may expose me to dangers from both known and anticipated risks.  I attest and verify that I am physically fit and my physical condition has been verified by a licensed medical doctor.  I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason.   Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
TEAM NAME:
I agreeI do not agree
INDIVIUAL - $30.00 8 a.m - 10 a.m.
PARTNERS - $50.00 10 a.m. - 12 p.m
3 PERSON TEAMS - $75.00 12 p.m. - 2 p.m.
4 PERSON TEAMS 500 piece - $100.00 - 2 p.m.-4 p.m.
4 PERSON TEAMS 1000 piece - $100.00 4 p.m. - ??