| Boaters Name: | Are You More than 18 Years Old? YN |
| Address: | |
| City: | State: Zip: |
| Phone: | |
| Boaters Signature: | ______________________________________ Date:___________ |
| Non-Boaters Name: | Are You More than 18 Years Old? YN |
| Address: | |
| City: | State: Zip: |
| Phone: | |
|
Non-Boater Signature:
|
______________________________________ Date:___________ |
| Boat Information Make/Length/H.P.: |
By the Entrants signatures above, entrants declare that they are familiar with the tournament rules and that they will abide by them. The Entrants signatures above also release the Chautauqua Lake Bassmasters, it’s Officers, Members, Agents, Employees, the Sponsors, Tournament Officials and other Contestants from all claims and liabilities for injuries, death and /or damages from the entrant or entrants family members that may be sustained by reason of participating in, or in conjunction with the tournament. Parent or legal guardian must also sign for entrant less than eighteen (18) years old.
For additional information
Tournament Director: Randy Crist
Call 716-484-7348
or 716-481-3408