2017 Chapter Road-E-O Registration
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May 10, 2017 SWANA-Georgia Chapter Landfill Equipment, Truck & Mechanic Road-E-O Athens, GA Georgia Square Mall Parking Lot & Athens-Clarke County Landfill Event lodging has been arranged at the Hotel Indigo Athens, GA. Call (866) 808-1483 to reserve your room by May 3. Ask for the SWANA-GA block room rate of $119 + $10 parking, per night. *Rooms are limited. First come, first served* This year we are also partnering with the American Public Works Association (APWA) and have added a backhoe competition for the APWA participants. Want to Sponsor? Check out sponsorship opportunities at www.gaswana.org. Participate in the 2017 state Road-E-O on May 10 ... and possibly qualify to compete in the 2017 International Road-E-O. Competitors may compete in up to two of the following events at the state level: EQUIPMENT CATEGORY EVENTS SCHEDULE -Off Road Truck -Dozer Tuesday, May 9 -Rubber Tire Loader 6:00 pm -Track Hoe *Hotel Indigo -Back Hoe (APWA only) Evening Reception - Heavy Appetizers TRUCK CATEGORY EVENTS Wednesday, May 10 -Automated Truck 7:30 am -Residential Rear Loader *Equipment Category Participants should report -Commercial Front Loader !to the ACC Landfill. -Tractor Trailer *Truck Category Participants should report to the -Roll-Off !Georgia Square Mall Parking Lot. *Mechanic Category Participants should report MECHANIC CATEGORY EVENT !to the Georgia Square Mall Parking Lot. -All-in-One Equipment/Trucks Registration - Breakfast Biscuit & Coffee Please note: *If fewer than three people register for a category, 8:00 am Written Test! participants will be asked to choose a different one in which to compete. 12 noon - Lunch at the ACC Landfill *If a participant wins in more than one event -- and (Participants at the Georgia Square Mall will be moves on to the International event -- he/she must shuttled back to the ACC Landfill) choose to compete in only one event at the higher level. SWANA-Georgia will sponsor competitors who Following the conclusion of competition, an qualify for the International Road-E-O, but retains the Award Ceremony will be held at the ACC Landfill. right to make all travel arrangements, including, but not limited to: registration fees, hotel, etc. A set per diem will be allowed for meals for these competitors. Directions to Hotel Indigo: indigoathens.com/hotel-near-uga/directions Directions to ACC Landfill 5700 Lexington Rd, Winterville, GA: From Hotel Indigo, take North Ave, take a right to merge onto Inner Loop 10 / US-129 S / US-441. Keep right or Exit 10C Watkinsville/Lexington. In 2.5 Miles Take Exit 8 onto Oconee Street/Lexington Road Take a right onto Lexington Road. In approximately 5 miles, take a left onto Landfill Road. Directions to Georgia Square Mall Parking Lot - 3700 Atlanta Hwy Athens, GA: From Hotel Indigo, take W. Dougherty and Prince Ave. to Outer Loop 10 / US-129 S. Continue on Loop 10 for 3 miles, then take Exit 18 Atlanta Highway/Monroe. Keep to far right lane to continue into Georgia Square Mall Access Road. Mall parking lot will be on your left. For more information contact: Stephanie Hubbard hubb92@bellsouth.net (770) 822-9308 Suki Janssen suki.janssen@athensclarkecounty.com (706) 247-5386 SPONSORSHIP REGISTRATION IN KIND & EQUIPMENT DONORS !*LOGO (must be provided by April 21) printed in one color on back of Event T-Shirt SPONSORS !*Name Recognition on General Signage/Chapter Website MUST COMMIT GOLD SPONSOR ($1000)! BY APRIL 21TH !*Exclusive Signage During Lunch & Table Space to Display Organization Material TO ENSURE !*LOGO (must be provided by April 21) will be printed in one color on a sticker, RECOGNITION !and sticker will be placed for one year on the new, SWANA ROAD-E-O trailer AS LISTED !*LOGO (must be provided by April 21) printed in one color on back Event T-Shirt ABOVE. !*Sponsorship Recognition on Event Signage/Chapter Website Please send SILVER SPONSOR ($500)!! LOGOS to !*NAME printed in black on Event T-Shirt Stephanie !*Sponsorship Recognition on Event Signage/Chapter Website Hubbard at BRONZE SPONSOR ($250) georgiaswana@g !*Sponsorship Recognition on Event Signage/Chapter Website mail.com Scan & email to georgiaswana@gmail.com, or fax to (770) 338-2735 ON OR BEFORE APRIL 21. Or mail to SWANA-Georgia, 823 Prada Court, Lawrenceville, GA 30043. **Sponsors who ALSO want to VOLUNTEER, MUST additionally complete the VOLUNTEER portion of this package.** !!! Name:!!!________________________________________________________________ Organization:!!________________________________________________________________ Address:!!!________________________________________________________________ !! Phone Number:!__________________ Email Address:!______________________________ SPONSOR PAYMENT: _____Please find enclosed a CHECK (made payable to SWANA-Georgia Chapter) for payment (or) _____Please charge the following CREDIT CARD: Card # ____________________________________________________ Exp. Date _______ 3- or 4-digit security code ________________!Zip Code for Billing Address __________________ Email Address for Receipt!_______________________________________________ Check the selected level of sponsorship. Submit registration, and logo if required, by April 21. ________!! IN-KIND & EQUIPMENT DONORS !!!*(Must provide logo to georgiaswana@gmail.com by April 21.) ________!! GOLD SPONSOR ($1000)!! !!!*(Must provide logo to georgiaswana@gmail.com by April 21.) ________!! SILVER SPONSOR ($500) !! ________!! BRONZE SPONSOR ($250) COMPETITOR & VOLUNTEER REGISTRATION Scan & email to georgiaswana@gmail.com, or fax to (770) 338-2735 ON OR BEFORE MAY 3. Or mail ON OR BEFORE MAY 3 to SWANA-Georgia, 823 Prada Court, Lawrenceville, GA 30043. I am registering as: _____ A Competitor ($100 or $150) _____A Volunteer (no charge) Name:!! ! ________________________________________________________________ Organization:!! ________________________________________________________________ Address:!!________________________________________________________________ !!!________________________________________________________________ Phone Number:!________________________________________________________________ Email Address:!________________________________________________________________ EVERYONE ATTENDING THE ROAD-E-O, regardless of participation capacity, MUST SIGN THIS LIABILITY RELEASE: I, ________________________________________________________________ !!!!!(print name) hereby request the opportunity to participate during the SWANA-Georgia Landfill Equipment, Truck, and Mechanic Road-E-O, sponsored by the SWANA-Georgia Chapter in Athens-Clarke County on May 10, 2017. In consideration of the opportunity to participate in the Road-E-O (be it as a competitor, volunteer, sponsor, or in any other capacity), I do hereby for myself, my heirs, personal representatives and assigns, release and discharge the Solid Waste Association of North America (SWANA), the Georgia Chapter of SWANA, and the sponsors, their respective agents, employees and officers, from all claims, demands, suits, actions and causes of action of any kind for bodily injuries sustained by me and for damage to and/or loss of personal property arising out of my participation in the event. I understand that participation in the program involves certain inherent risks and potential hazards, which I have considered and which I knowingly assume. I have read this release and understand all of its terms, and I execute it voluntarily. Signature:!!________________________________________________________________ Date:!!!________________________________________________________________ COMPETITOR PAYMENT: _____Please find enclosed a CHECK (made payable to SWANA-Georgia Chapter) for payment (or) _____Please charge the following CREDIT CARD: Card # ____________________________________________________ Exp. Date _______ 3- or 4-digit security code ________________!Zip Code for Billing Address __________________ Email Address for Receipt!_______________________________________________ ! ROAD-E-O REGISTRATION FORM (page 2 of 2-please complete both pages) COMPETITORS - Complete this section in with your immediate supervisor. SWANA/APWA member you are affiliated with (if not you): ______________________________ Event #1 you wish to compete in: !!_____________________________!$100 Event #2 (optional) you wish to compete in:!_____________________________!$50 !!!!!!!(*NOT applicable to APWA competitors.) ----------------------------------------------------------------------------------------------------------------------------------- CERTIFICATION REQUIREMENT (to be completed by competitor’s immediate supervisor) Do you certify that the employee has had no chargeable accidents or moving violations within the last 12 months? If so, please complete the following: “I do certify that this employee, ___________________________________ !!!!!!(print employee’s name) has had no accidents or moving violations within the last 12 months.” __________________________________!__________________________________ (Immediate Supervisor’s Signature)!!(Date Signed) VOLUNTEERS - Please select the area in which you would like to volunteer. While SWANA-Georgia cannot guarantee placement, we will try to place volunteers as requested. I would like to volunteer as: We will contact you VIA EMAIL the week before the ________!EQUIPMENT CATEGORY JUDGE Road-E-O with your general !!(located at the Athens-Clarke County Landfill)! volunteer assignment, so that you will know which ________!TRUCK CATEGORY JUDGE location to report to on !!(located at the Georgia Square Mall Parking Lot) Wednesday morning. Please