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FISHING BENEFIT ENTRY FORM
| 1ST ANNUAL MULTI-SPECIES FISHING BENEFIT MELVERN LAKE Entry Fees: $60 per team or $50 with 10 canned goods |
ANGLER #1 INFORMATION: Name_______________________________________________ Address______________________________________________ City_________________________________________________ State_____________________ Zip________________________ Home Phone _________________________________________ Email_______________________________________________ PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only): Last Name_________________________First Name______________________________ Address_________________________________________________________________ City_______________________________________________ State________________________ Zip__________________ ANGLER #2 INFORMATION: Name______________________________________________ Address_______________________________________________ City__________________________________________________ State________________________ Zip______________________ Home Phone ___________________________________________ Email_________________________________________________ PARENT/GUARDIAN INFORMATION (for persons under 18 years of age only): Last Name_________________________First Name_______________________________ Address___________________________________________________________________ City_______________________________________________ State________________________ Zip__________________ By signing below the participant (or parent/guardian) acknowledges the following: 1)All participants represent that they are physically and mentally competent and fit and able to participate. By entering, all participants agree to assume all risks of personal injury, death, and damage to or loss of property and further agree to indemnify and hold Hunt 4 Hunger, its organizers, and sponsors harmless from and against any and all claims, liabilities, and causes of action resulting directly or indirectly from participation. 2) Acknowledges and fully understands that he or she will be engaging in activities that involve risk of serious injury, including permanent disability and death, not only from his .her own actions, inactions, and negligence of others and condition of the equipment used. Furthermore, there may be risks not reasonably foreseeable at the time. 3)Furthermore, the participant acknowledges that they have read and understand the benefit rules and agrees to abide by all local , state, and federal fishing and boating laws and regulations while participating in the tournament. The participant also acknowledges that they may be photographed during the benefit, and they consent to the use of those photographs for the promotion of the benefit and Hunt 4 Hunger. The undersigned has read the above waiver and release and understands that he/she has given up substantial rights by signing it and does so voluntarily. Signed______________________________________________________________ Date________________________ Signed______________________________________________________________ Date________________________ Please send this completed entry form to: Hunt 4 Hunger Attn: Chuck Gardner 1102 Union Emporia, KS 66801 Make checks payable to: Hunt 4 Hunger A $35 fee will be charged for all returned checks. |
