Captains Name: ________________________
Mailing Address: _______________________
Town/City: ____________________________ Province: ____________
Postal Code: ___________________________ Phone: ______________
Email:________________________________
Partners Name:_________________________
Mailing Address:_______________________
Town/City: ____________________________ Province: ____________
Postal Code: ___________________________ Phone: ______________
Email:________________________________
Comments/Suggestions:___________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Make cheque/money order for $150.00 payable to: Shebandowan Smallmouth Showdown
Waiver of Claim Release and Indemnification agreement in consideration of the acceptance of my entry in the Shebandowan Smallmouth Showdown, it’s promoters, employees, sponsors, organizers, host, directors, officers, and all other organizers and affiliated organization, agencies and/or agents and assignees and any other person assisting in this event from any claims for damages or injuries suffered by me as a result of my participation in or traveling to or from the event. I hereby state that I am in proper physical condition to participate in this event and am aware that participation could, in some circumstances, result in physical injury. I further agree to indemnify Shebandowan Smallmouth Showdown et. al. (mentioned above), from any claims or damages arising out of or in consequences of the participation or attendance by me in this event. If under the age of eighteen, this waiver of claim, release and indemnification agreement must be signed by a Parent or Legal Guardian.
Entry and Acknowledgement:
Having read the rules and regulations, I hereby
submit my entry form for the registration and enclose my entry fee payable to
the . By signing this form I agree with the rules and agree to abide by said
rules.
Captains Signature: ________________________
Date Signed:________________________
Partners Signature: ________________________
Date Signed:_________________________
Fill it out and send your $150 (cheque or money orders only) payable to: Shebandowan Smallmouth Showdown, entry fee to:
Shebandowan Smallmouth Showdown
P.O. Box 21138
Thunder Bay, Ontario
P7A 3S0