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Text Box: Name:_______________________________ Partner’s name:______________________________ Address:_____________________________ Address:____________________________________ City:________________________________ City:_______________________________________ State:__________ Zip:__________________ State:___________ Zip:________________________ Phone: ( )__________________________ Phone: ( )________________________________ Horsepower of boat motor:_______________ Make & model of boat:__________________ In signing this application, I hereby waive and release all other contestants, the host, sponsors, and tournament officials from all claims of injury and/or damage incurred in connection with this tournament. I further understand and agree that the tournament committee reserves the right to refund this entrance fee if it shall choose at any time or for any reason not to accept my application. I swear that the above facts are true and accurate to the best of my knowledge. Signature:______________________________ Signature:__________________________________ Date:__________________________________ Date:______________________________________ $10 for big bass can be included with payment, or paid at ramp Mail completed application to: Team Bass C/O Charlie Getty 13011 Neff Rd. Clio, MI 48420

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