Print clearly:

Boater Name: _____________________________________________________

Address:__________________________________________________________

City:_______________________ State: __________ Zip: ___________________

Home Phone: _____________________ Other Phone: _____________________

E-mail: ___________________________________________________________

Boat & Motor Description:____________________________________________

Non-Boater Name: __________________________________________________

Address:__________________________________________________________

City:_______________________ State: __________ Zip: ___________________

Home Phone: _____________________ Other Phone: _____________________

E-mail: ___________________________________________________________

By signing this form, do hereby agree to abide by all the tournament rules and waive and

release all persons connected with this tournament from all claims of injury and /or damage

incurred while participating in this tournament.

Boater Signature & Date:

_________________________________________________________________

Non-boater Signature & Date:

________________________________________________________________________

Official Entry Form