Official Entry Form

Please fill out all required fields. Once submitted please mail in your check for $50.00 to CKLC, PO Box 415 Pacific City, Oregon 97135, or call Moment Surf Co at 503-483-1025 to make a payment by phone.

Unpaid registrants will not be entered into the contest.

The following divisions are full and further applicants for them will be placed on waiting lists:

- Womens Division

- 18 to 29 Division

- 30 to 39 Division

- 40 to 49 Division

Competitor Information:
First Name
Last Name
Birthday (md/dd/yy)
Email Address
Competition Group / Age Group
Surfing Division
Please check size
A free T-Shirt is included with your entry fee. If you would like to make sure you get a hoodie, please add $35 to the entry fee below.
Hoodie size
No hoodie
By submitting this form, I agree to all contest rules. I agree to surf only in my heat and within the designated area. I will display good sportsmanship in and out of the water. Any violation will be subject to disqualification, including forfeit of any entry fee and contest points. I give my permission to have any video or pictures taken to be published or broadcasted as well as contest results. I am aware of the dangers and cautions of surfing and agree not to compete if I am unsure of the conditions. I agree to hold only myself accountable for any injury or damage that may occur during the surf contest. In addition, I understand that surfing is an inherently dangerous sport. By my participation in this activity and contest I hereby assume all risks associated therewith including (but not limited to): weather conditions, surf conditions, marine flora and fauna, other surfers, spectators, geography, equipment malfunction, and negligence. I furthermore agree to hold harmless the sponsors, the officials, and the organizers for any personal injury or property damage I may suffer as a result of my participation in this event or for any negligent act of omission associated there within.

By submitting this form, I hereby certify that I am 18 years of age and have read and understand this release or am under 18 years of age and my parents or legal guardian have submitted this form on my behalf.
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