Tattoo Registration Form

Please enter the information for your entry into the form below and click on the Submit Entry Form button to submit your entry.

After you have filled in the form and clicked on the Submit Entry Form button, a summary of the information you entered will appear. In order to complete your registration, please print a copy for your records. If you have questions, call the event organizer, Ann Murrow at 970-4400 or 512-267-9269 (fax).

* indicates a required field. You must fill in all required fields in order for your entry form to be accepted.

First Name:* Last Name:*
Street Address:* City:*
State:* Zip Code:*
Phone Number:* Emergency Phone Number:*
E-Mail:
(Please see note (1) below)
Birthdate:*
(Please see note (2) below)
Gender:*
Comments:
(1) Please enter an e-mail address if possible. If you specify an e-mail address, a copy of your entry form will be sent to the e-mail address you provide. You will also receive e-mail confirmation of your entry as well as further details regarding the Tattoo Contest within five days of the receipt of your completed entry form.
(2) Participation is restricted to those 21 or older
Release from Liability and Indemnification
We wish to participate in the Lago Vista July 4th Tattoo Contest. We, individual(s) or organization, Indemnify and Hold Harmless the Lago Vista 4th of July Council, its Volunteers, the City of Lago Vista from any and all claims, suits, losses, damages, expenses on account of the Tattoo Contest. Further, the noted individual(s) or organization will defend the Lago Vista 4th of July and the City of Lago Vista, and its agents from all claims or bodily injury or property damage arising from their participation in the Lago Vista July 4th Tattoo Contest. We understand that we are responsible for our own safely and actions. By checking the box below, I, the individual named in the First Name and Last Name boxes above, signify that I have read this Agreement and understand and agree to all its terms.
I have read the above Release from Liability and Indemnification
agreement and understand and agree to all its terms.
I agree