D.A.R.E. “2012” BENEFIT TOURNAMENT

APRIL 22, 2012

ENTRY FORM

(Entry Fee $120/Team; Lunker $10/Team; Parking $5)

BOAT OWNER	TEAM MEMBER
Name: ______________________________	Name: ______________________________
Street: ____________________________	Street: ____________________________
City: ______________________________	City: ______________________________
State: _______________Zip:__________	State: _______________Zip:__________
Phone no.: _______________________	Phone no.: _______________________
Email: ______________________________	Email: ______________________________
Boat Make: ___________________________	Length: _________________HP_________
Registration: __________________________	Insurance: _____________________________

THE UNDERSIGNED HEREBY RELEASES AND DISCHARGES THE NORTHEAST BASS ANGLERS AND ITS MEMBERS, OFFICERS AND SPONSORS FROM ALL CLAIMS, DEMANDS, RIGHTS OF CAUSE OF ACTION, PRESENT AND FUTURE, RESULTING FROM, ARISING OUT OF, OR INCIDENT TO, THE UNDERSIGNED’S PARTICIPANTS IN SAID TOURNAMENT.

ENTRY FORM MUST BE SIGNED BY BOTH TEAM MEMBERS

Signed _________________________________ Signed _______________________________

EARLY REGISTRATION: CHECKS MADE PAYABLE TO N.E.B.A. WILL BE ACCEPTED UP TO APRIL 13th AND SHOULD BE MAILED TO:

Brian Walachy

C/O NORTH EAST BASS ANGLERS

11 Pheasant Dr

Holyoke, MA 01040

CHECKS WILL NOT BE ACCEPTED AFTER APRIL 13th
CASH PAYMENTS ONLY AT LAUNCH SITE (APRIL 22nd – SUNDAY)

*****MUST BE PRESENT TO COLLECT CASH PAYOUTS*****

LIFE VESTS MUST BE WORN UNDER GAS POWER OPERATION
FLW RULES APPLY (along with local rules presented @ site)

For more information please call: Skip @ (413) 537-1214 or Brian @ (413) 531-4962