Official Entry Form 2008 St Jude

Official Entry Form
2012 St Jude / Dick Hiley Memorial Bass Classic
BENEFITING ST. JUDE CHILDREN'S RESEARCH HOSPITAL
ENTRY FEE: $350.00 per team until April 1st. $400.00 per team April 2nd through April 22nd.
Tournament Entry Deadline is April 22nd, 2012. Entries postmarked after April 22nd will not be accepted.
Please Print This Form and Mail to Address Below:
PDF Link to Entry Form if preferred

Team Captain (1)_____________________________________________________________

Mailing Address _____________________________________________________________

City/State/Zip ________________________________________________________

Home Telephone ________________________________________________________

Work Telephone __________________________________SS#_____________________

Email Address: _______________________________________________________

Shirt Size: ______ Will you bring a guest? Y or N How many guests? _____

Co-Captain (1)_____________________________________________________________

Mailing Address _____________________________________________________________

City/State/Zip ________________________________________________________

Home Telephone ________________________________________________________

Work Telephone __________________________________SS#_____________________

Email Address: _______________________________________________________

Shirt Size: ______ Will you bring a guest? Y or N How many guests? _____

Payment in full $350 until April 1st. $400 April 2nd through April 22nd.
Make checks payable to Zumbro Valley Bassmasters.
Mail entry and check payment to:
Zumbro Valley Bassmasters
c/o Eric Ronningen
6556 70th Ave. NE
Rochester, mn. 55906

Boating Liability insurance?_________
Company__________________________________________________________________
Please attach copy of policy. (See Rule VII.) Failure to provide a copy will result in rejection of your entry. No exceptions!

OFFICIAL WAIVER
In consideration of my being accepted to participate in the Tournament, I agree as follows:

1. I assume all risk of injury or death and loss of personal property which may result from my participation in the Tournament.

2. I hereby release and discharge the Sponsor, the Beneficiary, other participants and their respective officers, directors, officials, representatives, agents and employees from any and all liability, obligation, loss, damages, claims or causes of action in any way resulting from or arising out of the Tournament. I grant this release and discharge with full knowledge and awareness of the inherent danger associated with competitive fishing events such as the Tournament.

3. I agree to comply with any and all requirements of the Tournament with respect to procurement of liability insurance for use of my boat in the Tournament.

4. I have read and am familiar with the rules and agree to abide by all rules of the Tournament and further agree that resolutions of any disputes and other decisions made by the Tournament Director or other Tournament Officials shall be binding and conclusive and not subject to legal or administrative appeal.

5. I agree that any and all photographs, videos or filming of the Tournament which includes me, my name and/or my boat made during my participation in the Tournament may be used by the Sponsor or Beneficiary or the news media without my prior consent and without royalty or other compensation of any kind to me.

(1)___________________________________Date______________ State Fishing License #______________________________
(2)___________________________________Date______________ State Fishing License #______________________________
Signatures (Must be signed by both contestants)

Referred By:________________________________________

Received Date:_______________________________________