Wisconsin Senior Games. June3-17. Registration Deadline May 19, 2017 On-line Registration Available. Proudly supported by

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1 Wisconsin Senior Games June3-17 Registration Deadline May 19, 2017 On-line Registration Available Proudly supported by

2 Acknowledgments We thank the many volunteers who have given their time and talents to make the Wisconsin Senior Games what they are today. We look forward to an exciting two weeks filled with athletics, camaraderie, and memories once again. A special thank you to Wells Printing & Digital Services and Athens to Atlantis for their support and partnership. Wisconsin Senior Games is proudly supported by All Saints Neighborhood. Making a Difference The Wisconsin Senior Games wants to sincerely express our gratitude to the participants who made a donation to our organization. "It really does make a difference." Thank you! John R Olson Paul C. Aspinwall Reggie J. Hennessey Jack Sorenson William S Jankovich Don Singer Russell W. Crane James B. Schommer Du Wayne A Kittleson Monte K Hottmann Bob Mc Coid Gen Engel Robert H Berninger Ivy H Dowd Silas Johnson Patrice L. Nicolet Dennis E Dowd Frank W. Kilpatrick Richard G. Belshaw John QA Smith Dave Dydahl Tom M. Anderson Lyle W. Haried Frank A. Balistreri Emy Imhoff Larry W Quam Rose Stuvetraa Herman Torosian Donald A. Schultz Patrick Campbell Jeanine C. Maly John K. Baumann Gary Schill David W. Lesniak Neil F. Milbert Jerry L. Capps Peder N. Melhuse Donald W. Olman Michael J. Gehn Mary A. Schick Carol J. Pederson Bruce C. Kelly Andrew G. Homburg Chuck K Henrikson Donald Hoeppner Gary Mill Gloria Prosa Gregg C Fergus Harold S Tetzlaff Jerry Blevins John C Neupert Lyndon (lynnie) S Clemens Mary P Erdman Michael J Berndt Michael J Heller Pamela Stangl Scott P Erwin Thomas Charkowski Tom R Berg MSCR Goodman-Rotary 50+ Fitness A variety fun of activities! Core & Balance, Outdoor Endeavors, Kayaking, Strength, Dance, Fitness, Tai Chi, Walking Yoga and more! Recreation for all ages! Arts & Enrichment Youth Sports Adult Sports Fitness Soccer Adaptive Sports Paddling & Boating Swimming, Tennis and more! or

3 210 South Main Street Verona, Wisconsin Phone: (608) Bus. Hwy. 151 & 18 east Mt. Horeb, Wisconsin Phone: (608) YOUR FAMILY GROCER Like us on Facebook!

4 NUTRITION counseling PERSONAL TRAINING FREE TWO Week Membership Expires 8/31/17 Exercise Classes Basketball Racquetball Volleyball Lap Swimming Whirlpool Steam Room Sauna OPEN 24 HOURS ONLY $29/mo COTTAGE GROVE 1609 Landmark Lane MCFARLAND 5720 US Highway MONONA 5413 Monona Drive FITCHBURG 5956 Executive Drive HILLDALE 625 N. Segoe Road MIDDLETON 2510 Allen Blvd

5 The 2017 Senior Games Wisconsin Senior Games offers competitive events in the Madison Area. The 2017 games are held from June 3th to June 17th and are for adults age 50 and over. Events are divided by age brackets and men s and women s categories. Participants may choose to enter any number of events. Team events include volleyball, basketball, and softball. See for more details and the latest information. General Requirements and Rules Registration: Registrations for all events must be postmarked on or before the Extra registration form: for friend or family T-Shirts: deadline. This year the registration deadline is May 19, On-site registrations may be accepted at the discretion of the event chairperson. Wisconsin residency is not required. All active participants, who have registered by the registration deadline, will have the option to get a t-shirt. Shirts will be distributed at each participant s first event. If participant has not registered by the registration deadline the Wisconsin Senior Games cannot guarantee a t-shirt. Minimum Age: Participants must be at least 50 years of age on December 31st Check In: Walk-in Participant: Participation Divisions: Age Categories: Awards: Inclement Weather: Registration Form: Please note: Participants are asked to check in at each event site one-half hour before the event begins. If allowed by event chair, must be paid in check or cash. No credit cards at event sites. Rules There will be separate men s and women s competition in the following events: Basketball (3 on 3), Basketball Skills, Bowling, Golf, Pool, Pickleball, Swimming, Tennis, Table Tennis, Track & Field, and Volleyball. The events can have either 5-year, 10-year or no age categories. Age categories start at the age of 50. The top three participants in competitive events in each age group will receive awards following the event. If fewer than three participants are entered in a category, age categories may be combined. Wisconsin Senior Games reserves the right to cancel events due to inclement weather. In case of bad weather, events may or may not be rescheduled and refunds may or may not be provided. Each participant must complete a Wisconsin Senior Games registration form and sign and date the Waiver and Release of Liability Clause. Failure to complete and provide this form may lead to disqualification. Wisconsin Senior Games reserves the right to combine age and gender brackets, or to cancel events due to limited registrations. On-line registration available WISCONSIN SENIOR GAMES

6 Specific Event Requirements All Events: Please check in at your event location at least 30 minutes before the event is scheduled to begin. Basketball (3 on 3): Each team must wear shirts of identical color. Gym shoes are required. Team registration is required. Bowling: Be sure to enter your bowling average on the registration form. Golf: If you desire specific tee time or to play with a pre-arranged foursome, call Mark Hanson, before June 5th. Pickleball: There are singles, doubles, and mixed doubles events. There will be three age divisions: 50-59, 60-69, and 70 and over. Please come one-half hour early. Paddles, nets, and balls are provided. Slow Pitch Softball: This is a team sport played under Senior Softball Slow Pitch Rules. There will be two age divisions: and 65 and over. PLEASE NOTE: In addition to the individual registration form, a team registration form is also required (see team registration form). No metal spikes allowed. Game balls will be furnished. Teams must furnish all other equipment. Table Tennis: Bring your own paddles if you have them. Tennis: For 2017, tennis will be men s doubles, women s doubles, and mixed doubles only. Partner s name must be included on registration form. Volleyball: This is a team sport for men or women. PLEASE NOTE: In addition to the individual registration form, a team registration form is also required (see team registration form). National Senior Rules apply. Teams must provide practice balls. Please note: Wisconsin Senior Games reserves the right to combine age and gender brackets, or to cancel events due to limited registrations WISCONSIN SENIOR GAMES 2 On-line registration available

7 2017 Event Chairpersons Basketball (3 on 3) Reggie Hennessey Basketball Skills John Schultz (free throws, three-point shot, hot shots) Bowling Bob Frambs CARDS John Smith Sheepshead (Monona Sr. Ctr.) Jerry Fuller Cribbage (Fitchburg Senior Ctr.) Mike Procknow Euchre (Stoughton Sr. Ctr.) Mike Procknow Euchre (Middleton Sr. Ctr.) Mike Procknow Euchre Mike Procknow (Warner Park Community CTR) Euchre Mike Procknow (All Saints Neighborhood) Dart Ball Lynn Forshaug Golf Mark Hanson Pickleball Fred Fry Pool - 8 Ball Allen McCredie woodsmaster41@gmail.com Softball Slow Pitch Reggie Hennessey president@wiseniorgames.org Swimming Deb Stevens CDML4910@charter.net Table Tennis Michael Berndt attymjb@aol.com Tennis Dennis Dowd dendowd@yahoo.com Track & Field Travis Bashaw travis@wiseniorgames.org John Schultz Trap & Skeet Larry Quam lquam@att.net Tom Lunde Volleyball Men Nancy Gille nanniegille@hotmail.com Volleyball Women Nancy Gille nanniegille@hotmail.com On-line registration available WISCONSIN SENIOR GAMES

8 2017 Wisconsin Senior Games Site Locations Fitchburg LOCATION STREET ADDRESS PHONE DIRECTIONS Ten Pin Alley, 6285 Nesbitt Rd From Hwy 18 & 151, West side of Madison, Fitchburg turn West on CTH PD. McKee Road, a traffic light, turn left at next traffic light. Nesbit Road and travel 0.7 mile to the alleys. Fitchburg Senior Ctr 5510 Lacy Rd Fish Hatchery Rd. south off beltline 2-1/2 miles, left on Lacy Rd. for ¼ mile. Senior Center is in lower level of Community Center. Madison LOCATION STREET ADDRESS PHONE DIRECTIONS All Saints 511 Commerce Dr West Beltline- exit Gammon Rd, go south- turn right Neighborhood onto Watts Rd- left onto Commerce Drive and left to building 511 Commerce. Bowl-A-Vard 2121 E Springs Drive Near East Towne Mall, across from Menards Dream Lanes 13 Atlas Court Take Stoughton Road (Hwy. 51) to Cottage Grove Rd exit. Head east to stoplight at Atlas (by Culver s) and turn left, then first right to Atlas Court. Madison Memorial 201 South Gammon Rd North on Gammon off Beltline High School Madison Table 2100 Winnebago St East Washington Ave to S. First St, 1 block, Tennis Club turn left onto Winnebago St, then straight ahead to Madison Table Tennis Club (turn left into Ford Gym parking lot) Powless Tennis 801 Struck Street Beltline Hwy to Gammon Road Exit, south on Center Gammon to Watts Rd, left on Watts, right on Struck St Princeton Club-East 1726 Eagan Rd East Washington Ave. to Eagan Rd Princeton Club-West 8080 Watts Rd Beltline Hwy to Gammon Rd, exit south on Gammon Rd, right on Watts Rd to Princeton Club West Pitcher s Pub 323 W. Beltline Hwy Enter via Rimrock Rd., right east Badger Rd. Schwoegler s 444 Grand Mineral Point Rd to Grand Canyon Dr Entertainment Ctr Canyon Dr Warner Park 1625 Northport Dr From Hwy 30, exit right to Packers Ave., Packers Community Ctr curves left to Northport Drive, left to Warner Park Recreation Center Middleton LOCATION STREET ADDRESS PHONE DIRECTIONS Bowling Green 7622 Lisa Ln US 12-18, exit Parmenter Street, Softball Complex continue to Lisa Lane Middleton Senior 7448 Hubbard Ave Center 2017 WISCONSIN SENIOR GAMES 4 On-line registration available

9 2017 Wisconsin Senior Games Site Locations CONTINUED Monona LOCATION STREET ADDRESS PHONE DIRECTIONS Monona Senior 1011 Nichols Rd Take beltline to Monona Dr., then head North Center on Monona to Nichols Rd (a Light), then left on Nichols Rd. to #1011. Monona Golf Course 111 E Dean Ave. Take beltline to Monona Dr, then head north on Monona and take a right onto Dean Ave. Mt Horeb LOCATION STREET ADDRESS PHONE DIRECTIONS Mt. Horeb Senior 107 N Grove St Hwy 18/ 151 west to the Mt, Horeb County Center Route ID exit. Go thru two stop lights and take the next turn right. The Community Center is in the lower level of the Library. Stoughton LOCATION STREET ADDRESS PHONE DIRECTIONS Stoughton 918 Collins Rd From Highway 51 on East side of Conservation Park Stoughton, go south and east on CTH A to Collins Road. Turn south on Collins Road to 918. Park is on left. Stoughton Senior 248 W. Main St Next to the bridge Center Sun Prairie LOCATION STREET ADDRESS PHONE DIRECTIONS Prairie Athletic Club 1010 N Bird St Hwy 151 east from Madison to 3 rd Sun Prairie exit (Bird St). Turn left on Bird to Club Waunakee LOCATION STREET ADDRESS PHONE DIRECTIONS Waun-A-Bowl 301 S Century Ave Main Street to round-about south on Century Ave.(Hwy Q) On-line registration available WISCONSIN SENIOR GAMES

10 2017 Wisconsin Senior Games Event Schedule Check the box EVENT AM PM WHERE Sat. June 3 1 Skeet 8:30 AM Stoughton Conservation Park Rain Date 6-4 Friday Wed Saturday 2 Trap 9:30 AM Stoughton Conservation Park Rain Date Track -50 meter dash 9:00 AM Memorial High School, Madison 4 Track -100 meter dash 9:00 AM 5 Track -200 meter dash 9:00 AM Key: 6 Track -800 meter race walk 9:00 AM Fee at Event 7 Field -Discus Throw 10:00 AM Memorial High School, Madison Team Registration 8 Field -Softball Throw 10:00 AM Form Required 9 Field -Standing Long Jump 10:00 AM Note Site Change 10 Field -Shot Put 10:00 AM 11 Field -Turbo Javelin Throw 10:00 AM Mon. June 5 12 Cards-Cribbage 1:00 PM Fitchburg Senior Center 13 Bowling 10:00 AM Bowl-A-Vard, Madison Tues. June Ball Pool 12:00 PM Pitcher s Pub, Madison 15 Cards-Euchre 1:00 PM Stoughton Senior Center 16 Dart Ball 1:00 PM Mount Horeb Senior Center Wed. June 7 17 Pickleball Singles (Men) 10:00 AM Prairie Athletic Club (Sun Prairie) 18 Pickleball Singles (Women) 10:00 AM Prairie Athletic Club (Sun Prairie) 19 Pickleball - Doubles (Men) 12:30 PM Prairie Athletic Club (Sun Prairie) 20 Pickleball - Doubles (Women)* 12:30 PM Prairie Athletic Club (Sun Prairie) 21 Pickleball - Mixed Doubles 5:30 PM Prairie Athletic Club (Sun Prairie) 22 Table Tennis 12:30 PM Madison Table Tennis Club 23 Cards-Euchre 1:00 PM All Saints Neighborhood 24 Bowling 6:15 PM Schwoeglers Entertainment Center Thurs. June 8 25 Cards-Euchre 1:00 PM Middleton Senior Center 26 Basketball-Free Throw 6:00 PM Princeton Club West 27 Basketball- Hot Shots 7:00 PM Princeton Club West 28 Basketball-3 Point Shot 8:00 PM Princeton Club West Friday June 9 29 Swimming 25m Breast Stroke 1:00 PM Princeton Club West 30 Swimming 50m Breast Stroke 1:00 PM Princeton Club West 31 Swimming 25m Back Stroke 1:00 PM Princeton Club West 32 Swimming 50m Back Stroke 1:00 PM Princeton Club West 33 Swimming 25m Free Style 1:00 PM Princeton Club West 34 Swimming 50m Free Style 1:00 PM Princeton Club West 35 Volleyball (Men) 5:30 PM Princeton Club East 36 Volleyball (Women) 5:30 PM Princeton Club East 37 Bowling 6:15 PM Ten Pin Alley, Fitchburg Sat. June Softball-slow pitch 10:00 AM Bowling Green Softball Complex Rain Date 6/17 Wed. June Golf-9 holes 10:00 AM Monona Golf Course 40 Bowling 6:15 PM Dream Lanes, Madison Thurs. June Tennis-Doubles (Women) 10:30 AM Powless Tennis Center, Madison 42 Tennis-Doubles (Men) 10:30 AM Powless Tennis Center, Madison 43 Cards - Euchre 1:00 PM Warner Park Community Center 44 Bowling 3:00 PM Waun-A-Bowl, Waunakee 45 Basketball (3 on 3) 6:15 PM Princeton Club West Fri. June Cards-Sheepshead 8:00 AM Monona Senior Center 47 Tennis-Mixed Doubles 10:30 AM Powless Tennis Center, Madison 2017 WISCONSIN SENIOR GAMES 6 On-line registration available

11 Wisconsin Senior Games 2017 Registration Form Must be post marked by May 19, 2017 Page 1 of 2 Please print legibly. Thank you! Updated April see for online registration NAME First Name MI Last Name ADDRESS Street City State Zip Code CONTACT INFORMATION Home Phone ( ) Work Phone ( ) Address ATHLETE INFORMATION Emergency Contact Name Emergency Contact Phone ( ) This address may be used to send you information about the Wisconsin Senior Games activities before, during, and after the games. Check here if you do not want to receive such s. Gender M F Date of Birth Month/Day/Year / / M M D D Y Y Y Y Age on December 31 st 2017 Failure to provide age and DOB info may result in rejection. Wisconsin Senior Games 2017 Shirt No, I do not want a shirt Yes, I want a shirt If, you answered Yes for a shirt, circle the size Team Sports Fill in only if you are on any of the team sports below* Tennis Partner Name* Doubles Pickle ball Doubles Partner Name* S M L XL XXL XXXL Softball Captain Name* Team Name* Volleyball Captain Name* Team Name* Bowling Average (if bowling) Basketball (3 on 3) Captain Name* Team Name* *If you would like to be on a team, and do not have enough participants, please contact the event chairperson for assistance (see pg 3) EVENT SELECTION Put an X by the event(s) in which you will be participating. Please also mark the same events on your schedule. 1 Skeet 2 Trap 3 Track-50 meter dash 4 Track-100 meter dash 5 Track-200 meter dash 6 Track-800 meter walk 7 Field-Discus Throw 8 Field-Softball Throw 9 Field-Standing Jump 10 Field-Shot Put 11 Field-Turbo Javelin 12 Cards-Cribbage 13 Bowling- Bowl-A-Vard 14 8-Ball Pool 15 Cards-Euchre, Stoughton 16 Dart Ball 17 Pickleball Singles(M) 18 Pickleball Singles(W) 19 Pickleball-Doubles(M) 20 Pickleball-Doubles(W) 21 Pickleball-Mixed Doubles 22 Table Tennis 23 Cards-Euchre 24 Bowling- Schwoeglers 25 Cards-Euchre 26 Basketball-Free Throw 27 Basketball- Hot Shots 28 Basketball-3 Point Shot 29 Swimming 25m Breast 30 Swimming 50m Breast 31 Swimming 25m Back 32 Swimming 50m Back 33 Swimming 25m Free 34 Swimming 50m Free 35 Volleyball(M) 36 Volleyball(W) 37 Bowling 38 Softball-slow pitch 39 Golf-9 holes 40 Bowling-Dream Lanes 41 Tennis-Doubles (W) 42 Tennis-Doubles (M) 43 Cards - Euchre 44 Bowling 45 Basketball(3 on 3) 46 Cards-Sheepshead 47 Tennis-Mixed Doubles

12 Wisconsin Senior Games 2017 Registration Form Must be post marked by May 19, 2017 Page 2 of 2 EVENT REGISTRATION COSTS see for online registration The first event is $12 ($10 for cards) and $5 for each additional event. Wisconsin Senior Games Special Offer: Unlimited events for $40.00 (excludes on-site fees). DETERMINE YOUR COST For each item that applies, enter that amount in the subtotal to the right. No. ITEM ACTION REGISTRATION COST/EVENT SUBTOTAL 1 1 st Event $12 ($10 for Cards) $ 2 Activity Events Additional Events # of additional Events Multiply by $5 per event $ 3 Add the subtotals from lines 1 and 2 $ 4 Enter the lesser of the the total of line 3 or $40 (the WSG offer for unlimited events) $ a. Softball $ 5 Site event fees are additional fees to defray facility and/or officiating costs of specific events. The added cost is $6 per event. b. Track and field $ c. Volleyball $ 6 I want to be a Friend of WSG and make a tax-deductible contribution here $ 7 Your Cost for Wisconsin Senior Games 2017 Registration (add lines 4, 5a, 5b, 5c & 6) TOTAL $ Please make checks payable to Wisconsin Senior Games for the total. Send check and all pages of the registration form to: Wisconsin Senior Games For questions about registration call: Madison Senior Center Reggie Hennessey at West Mifflin St Madison, WI In addition to the event registration cost (above), the following events require on-site fee payment (at the time of competition only. Must be paid in check or cash, no credit cards.) Please do not include these on-site fees with your registration form. On-Site Fees EVENT # EVENT FEE 1 Skeet/Stoughton Conservation Park $8 2 Trap/Stoughton Conservation Park $8 13, 24,37, $8 Bowling/All Locations (fee for each location where participate) 40,44 39 Golf-9 holes/monona Golf Course $14 to $21 (cart additional) Pickleball/Sun Prairie (one fee for multiple events, i.e. singles, $5 doubles, mixed doubles) 41,42, 47 Tennis/Powless Tennis Center ($5 per Doubles match) $5 (per match) WAIVER AND RELEASE OF LIABILITY - must be signed by all participants before allowed to compete. By registering/participating, I acknowledge that individual insurance is not provided for Wisconsin Senior Games events and agree to adhere to program rules. I warrant and represent that I am in good physical health and condition, and I am physically able to compete in the events I have selected. I know of no physical restrictions whatsoever which would prevent my participation in these events. I understand that competition is inherently dangerous and I am responsible for my own actions and the security of my private property. I do hereby, for myself, my heirs, executors and administrators, and anyone who may bring a claim on my behalf, waive, release, and forever discharge Wisconsin Senior Games, its officers and directors, agents, officials, volunteers and event sites, from liability for any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in Wisconsin Senior Games. In the event I am injured, I consent to the provision of emergency care. Please note: photos taken during events and competition may be used for educational or marketing purposes by the Wisconsin Senior Games. I hereby pledge that I am 50 years of age or older as of December 31, 2017 and eligible to participate in these games. By signing below, I understand and agree to the "Waiver and Release of Liability." Signature Date

13 Wisconsin Senior Games 2017 Registration Form Must be post marked by May 19, 2017 Page 1 of 2 Please print legibly. Thank you! Updated April see for online registration NAME First Name MI Last Name ADDRESS Street City State Zip Code CONTACT INFORMATION Home Phone ( ) Work Phone ( ) Address ATHLETE INFORMATION Emergency Contact Name Emergency Contact Phone ( ) This address may be used to send you information about the Wisconsin Senior Games activities before, during, and after the games. Check here if you do not want to receive such s. Gender M F Date of Birth Month/Day/Year / / M M D D Y Y Y Y Age on December 31 st 2017 Failure to provide age and DOB info may result in rejection. Wisconsin Senior Games 2017 Shirt No, I do not want a shirt Yes, I want a shirt If, you answered Yes for a shirt, circle the size Team Sports Fill in only if you are on any of the team sports below* Tennis Partner Name* Doubles Pickle ball Doubles Partner Name* S M L XL XXL XXXL Softball Captain Name* Team Name* Volleyball Captain Name* Team Name* Bowling Average (if bowling) Basketball (3 on 3) Captain Name* Team Name* *If you would like to be on a team, and do not have enough participants, please contact the event chairperson for assistance (see pg 3) EVENT SELECTION Put an X by the event(s) in which you will be participating. Please also mark the same events on your schedule. 1 Skeet 2 Trap 3 Track-50 meter dash 4 Track-100 meter dash 5 Track-200 meter dash 6 Track-800 meter walk 7 Field-Discus Throw 8 Field-Softball Throw 9 Field-Standing Jump 10 Field-Shot Put 11 Field-Turbo Javelin 12 Cards-Cribbage 13 Bowling- Bowl-A-Vard 14 8-Ball Pool 15 Cards-Euchre, Stoughton 16 Dart Ball 17 Pickleball Singles(M) 18 Pickleball Singles(W) 19 Pickleball-Doubles(M) 20 Pickleball-Doubles(W) 21 Pickleball-Mixed Doubles 22 Table Tennis 23 Cards-Euchre 24 Bowling- Schwoeglers 25 Cards-Euchre 26 Basketball-Free Throw 27 Basketball- Hot Shots 28 Basketball-3 Point Shot 29 Swimming 25m Breast 30 Swimming 50m Breast 31 Swimming 25m Back 32 Swimming 50m Back 33 Swimming 25m Free 34 Swimming 50m Free 35 Volleyball(M) 36 Volleyball(W) 37 Bowling 38 Softball-slow pitch 39 Golf-9 holes 40 Bowling-Dream Lanes 41 Tennis-Doubles (W) 42 Tennis-Doubles (M) 43 Cards - Euchre 44 Bowling 45 Basketball(3 on 3) 46 Cards-Sheepshead 47 Tennis-Mixed Doubles

14 Wisconsin Senior Games 2017 Registration Form Must be post marked by May 19, 2017 Page 2 of 2 EVENT REGISTRATION COSTS see for online registration The first event is $12 ($10 for cards) and $5 for each additional event. Wisconsin Senior Games Special Offer: Unlimited events for $40.00 (excludes on-site fees). DETERMINE YOUR COST For each item that applies, enter that amount in the subtotal to the right. No. ITEM ACTION REGISTRATION COST/EVENT SUBTOTAL 1 1 st Event $12 ($10 for Cards) $ 2 Activity Events Additional Events # of additional Events Multiply by $5 per event $ 3 Add the subtotals from lines 1 and 2 $ 4 Enter the lesser of the the total of line 3 or $40 (the WSG offer for unlimited events) $ a. Softball $ 5 Site event fees are additional fees to defray facility and/or officiating costs of specific events. The added cost is $6 per event. b. Track and field $ c. Volleyball $ 6 I want to be a Friend of WSG and make a tax-deductible contribution here $ 7 Your Cost for Wisconsin Senior Games 2017 Registration (add lines 4, 5a, 5b, 5c & 6) TOTAL $ Please make checks payable to Wisconsin Senior Games for the total. Send check and all pages of the registration form to: Wisconsin Senior Games For questions about registration call: Madison Senior Center Reggie Hennessey at West Mifflin St Madison, WI In addition to the event registration cost (above), the following events require on-site fee payment (at the time of competition only. Must be paid in check or cash, no credit cards.) Please do not include these on-site fees with your registration form. On-Site Fees EVENT # EVENT FEE 1 Skeet/Stoughton Conservation Park $8 2 Trap/Stoughton Conservation Park $8 13, 24,37, $8 Bowling/All Locations (fee for each location where participate) 40,44 39 Golf-9 holes/monona Golf Course $14 to $21 (cart additional) Pickleball/Sun Prairie (one fee for multiple events, i.e. singles, $5 doubles, mixed doubles) 41,42, 47 Tennis/Powless Tennis Center ($5 per Doubles match) $5 (per match) WAIVER AND RELEASE OF LIABILITY - must be signed by all participants before allowed to compete. By registering/participating, I acknowledge that individual insurance is not provided for Wisconsin Senior Games events and agree to adhere to program rules. I warrant and represent that I am in good physical health and condition, and I am physically able to compete in the events I have selected. I know of no physical restrictions whatsoever which would prevent my participation in these events. I understand that competition is inherently dangerous and I am responsible for my own actions and the security of my private property. I do hereby, for myself, my heirs, executors and administrators, and anyone who may bring a claim on my behalf, waive, release, and forever discharge Wisconsin Senior Games, its officers and directors, agents, officials, volunteers and event sites, from liability for any and all rights and claims for damages that I may have or that may hereafter accrue to me arising out of or in any way connected with my participation in Wisconsin Senior Games. In the event I am injured, I consent to the provision of emergency care. Please note: photos taken during events and competition may be used for educational or marketing purposes by the Wisconsin Senior Games. I hereby pledge that I am 50 years of age or older as of December 31, 2017 and eligible to participate in these games. By signing below, I understand and agree to the "Waiver and Release of Liability." Signature Date

15 Team Registration Form 2017 Wisconsin Senior Games PLEASE PRINT (Required for Volleyball, Slow Pitch Softball & Basketball) Name of Team Team Event Team Captain Ph. Home ( ) Work ( ) Team members are responsible to send in their own registration form with payment to the Wisconsin Senior Games. Team captains are responsible to complete this form listing team members and submit roster with their individual participant registration form to: Wisconsin Senior Games Madison Senior Center 330 Mifflin Street Madison, WI Final Registration Deadline: May 19, 2017 Softball captains please note new guidelines for registration under Specific Event Guidelines. Team Members (Please Print clearly) Name Phone Age If more space is needed, attach a second page. Photocopies of this form are accepted. * Teams will compete in age brackets based on the age (as of December 31st 2017) of the youngest team member registered above. On-line registration available WISCONSIN SENIOR GAMES

16 Teamwork Makes a Winner! Teamwork is a solid function in the mission of providing a successful year of Wisconsin Senior Games. With the election of officers to the Board of Directors, and the membership of that body, begins the process of working together to establish the policies, procedures, and delivery of the June Wisconsin Senior Games. However, it involves many more persons to assist in seeing that these items are carried out. We have the website coordinator, the printing company and its staff, the advertisers who support us, the different venues, the event chair persons who coordinate with the President to establish the timing and carryout of the planned activities and, last but not least, are the participants who bring it all to fruition as they work together to make the year a successful event for all. Seniors showing camaraderie after a tough softball game. Volleyball action at Princeton Club-East, featuring lobs, strikes and precise ball placement WISCONSIN SENIOR GAMES 12 On-line registration available

17 Board of Directors for Wisconsin Senior Games 2017 Reggie Hennessey, President 2409 McKenna Blvd., Madison, WI Vice President vacant Mike Procknow, Treasurer 9059 Ridgeview Road, Mt. Horeb, WI Ann Nord, Secretary 4029 Lori Circle, Madison, WI (608) Linda Bolles 5102 Black Oak Dr. Madison, WI Bill Brophy 6860 Park Ridge Dr., Madison, WI Dennis Dowd 729 Ash Ct, Verona, WI Mark Hanson 9 Plover Cr. Madison, WI Hanson.mark.ed@gmail.com Fernando Hernandez, 5831 Lupine Ln #321, Madison, WI (608) fernando@ wiseniorgames.org Emy Imhoff 2518 Dahle St., Madison, WI John Q. A. Smith 3834 Johns St., Madison, WI (608) Honorary Members Bob Frambs 1634 Angel Crest Way, Madison, WI (608) frambsbob@yahoo.com Mike Metcalf 7117 Maple Point Drive, Madison, WI (608) mmetcalf12@charter.net Jean O Leary MSCR - East 4620 Cottage Grove Road, Madison, WI (608) joleary@madison.k12.wi.us John Schultz 5006 Flambeau Rd., Madison, WI On-line registration available WISCONSIN SENIOR GAMES

18 Working on the registration book through the years Like clockwork, editing committee meets every year to prepare the information for the Wisconsin Senior Games Registration Book. Various Senior Center sites have provided computer support in the last few years. Thanks to the Madison and Fitchburg Senior Centers facilities pictured here Serving the Madison Area for Over 90 Years! 1/2 Page for Wells Printing 3121 Watford Way, Madison, WI WISCONSIN SENIOR GAMES 14 On-line registration available

19 6285 Nesbitt Rd. Fitchburg, WI We offer morning leagues on Monday-Wednesday-Thursday -Friday We offer daily lunch specials Open bowling every morning Kids birthday parties Private banquets Give us a call at Check us out on Facebook On-line registration available WISCONSIN SENIOR GAMES

20 NOW FORMING YEAR ROUND LEAGUES ON TUESDAYS WEDNESDAYS THURSDAYS AND FRIDAYS We provide Coffee, Donuts, Danishes, and Muffins SIGN UP TODAY! Call To Reserve Your Spot 2121 E. Springs Dr. Madison, WI Clarmar Dr. Sun Prairie, WI WISCONSIN SENIOR GAMES 16 On-line registration available

21 They were wonderful. adfinity East Madison/Monona West Madison/Middleton Stoughton Oregon Cross Plains Fitchburg Lodi (608) Conversation, coffee and 6000 sq. feet of antiques, collectibles, and retro for your enjoyment! Closed Monday Tues.-Fri Sat Sun S. Stoughton Road Madison, WI

22 There is More to Successful Aging Than you Think Successful aging can be defined as Avoiding Disease & Disability Engagement with Life Maintaining High Cognitive and Physical Function Daily Lunch Specials Homemade soups Friday Fish Fry Breakfast Saturday and Sunday's 161 Horizon Drive Suite 110 Verona, WI thquarter.biz 330 W Mifflin St Madison, WI Bringing you programs and events that promote successful aging: Aging Mastery Program Academic Lectures Art Classes & Exhibits PLATO Yoga & Simple Strength Computers & more! Create Your Own Glass Art Fused Glass Stained Glass Mosaic Flameworking 1422 MacArthur Rd. vineryglass.com Beginners welcome and encouraged. Many inspiring classes to choose from. Fun and friendly environment to explore your crea ve side!

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24 A NEIGHBORHOOD like neighborhoods used to be. Where friendships are forged, neighbor helps neighbor, and the community is bonded together by shared values. Cottages & Condos Apartments Assisted Living Memory Care Neighborhood Main Street with Café, Greenhouse & Chapel