Date:
December 4, 2004
Team Name (if applicable):
Team Captain Name:
Phone:
Email:
Address:
City:
State:
ZIP:
Main Division-Non-Member - $85
Main Division-Member $80
Big Trout Division- $20
Double Down-Non-Member - $85
Double Down-Member $80
Double Down Big Trout - $20
Angler #2 Name:
Phone:
Email:
Address:
City:
State:
ZIP:
Main Division-Non-Member - $85
Main Division-Member $80
Big Trout Division- $20
Double Down-Non-Member - $85
Double Down-Member $80
Double Down Big Trout - $20
Angler #3 Name:
Phone:
Email:
Address:
City:
State:
ZIP:
Main Division-Non-Member - $85
Main Division-Member $80
Big Trout Division- $20
Double Down-Non-Member - $85
Double Down-Member $80
Double Down Big Trout - $20
Total Amount (include correct entry and optional big
trout division entries):
If fishing as a team you must include entry for entire team.
Team Captain Signature: ___________________________________Date:
PARTICIPANT AGREEMENT, RELEASE AND ACKNOWLEDGEMENT
OF RISK: Upon signing this application, I hereby waive & release
all other contestants, host sponsors and tournament officials from
any and all liability claims, demands, actions or rights of action
which are related to, arise out of, or in any way connected with my
participation in this tournament, for any and all claims of death,
personal injury, accidents, theft and damage to myself, my partner,
to others and all equipment involved in fishing. I voluntarily assume
full and all responsibilities for my health and safe being arising
from my participation in this tournament. I assume responsibility
for all equipment on and off water during this tournament. I have
sufficient health, accident, and liability insurance to cover any
bodily injury or property damage incurred by myself or others as a
result of my participation in this tournament. If I have no such insurance,
I represent that I am capability of paying for any and all such expenses
or liability. I have read and understand the rules of this tournament
and I will obey all rules and understand that any violation may result
in immediate disqualification without refund of my entry fee. I also
understand that tournament officials may reject my application for
any reason and in that event will refund my entry fee. By signing
this application, I will submit to a polygraph if requested to do
so. If I fail to pass the polygraph, I will be disqualified. “Speck”tacular
Fishing Tournament Series has my permission to use my name, photograph
and film footage of me if it chooses to do so. My signature above
reflects that I have read the entire document, understand it completely,
understand it affects my legal rights and agree to be bound by its
terms. References to “I,” “me,” “my,” “myself,” and other first person
references shall include any child or ward to whom I sign.
Adult Signature: _________________________________________Date:
(If team captain is under 18 years of age) I hereby
claim responsibility for the minor above and have read and understand
the rules and release all of the above affiliated with the event from
all claims above..
BEFORE YOU HIT SUBMIT PLEASE
PRINT ENTRY FORM TO INCLUDE WITH YOUR CHECK IN THE MAIL.
Mail Entries at least 3 days before the event. Make checks payable to: Specktacular
Fishing Tournament, 5128 Arborwood, League City, TX 77573.
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