Entry Form

SENIOR BASS ANGLERS
Entry Form

BOAT CAPTAIN:______________________________________________________________________________

ADDRESS:__________________________________________________________________________________

CITY:__________________________________________________ STATE:______ ZIP:___________________

SOCIAL SECURITY#:_____________________________ EMAIL:_______________________________________

HOME PHONE: (_____)_________________________ CELL PHONE: (_____)_____________________________

BOAT USED:______________________ YR:_________ MAKE OF MOTOR:________________ HP:____________

HP BOAT RATING:________________________ TROLLING MOTOR: ____________________________________

Company Name, Policy # or Agent Binding coverage on boat to be used in Tournament (see Rule #15)

INSURANCE COMPANY:________________________________________________________________________

POLICY#: _____________________________________ AGENT:______________________________________

TOW VEHICLE:__________________________ MODEL: ____________________________ YEAR:___________

BONUS MONEY ELIGIBILITY

WAS YOUR BOAT PURCHASED AT CLARK MARINE? ____YES ____NO

DO YOU OWN A CUNNINGHAM VEHICLE? ____YES ____NO If YES, WHAT YEAR?________

BONUS MONEY IS AVAILABLE FROM SEVERAL BOAT MANUFACTURERS. IN ORDER TO QUALIFY, YOU MUST BE A CURRENT MEMBER. ARE YOU A MEMBER OF:

TRITON GOLD ____ RANGER CUP ____ PHOENIX FIRST FLIGHT ____

PARTNER NAME:_____________________________________________________________________________

ADDRESS: _________________________________________________________________________________

CITY:___________________________________________________ STATE:______ ZIP:___________________

SOCIAL SECURITY#:_____________________________ EMAIL:_______________________________________

HOME PHONE: (_____)_________________________ CELL PHONE: (_____)_____________________________

PER TOURNAMENT ENTRY FEE: $125.00 PER BOAT (Big Fish Pot of $10 per person collected at check-in.)

1ST TOURNAMENT ENTRY FEE - $125.00, PLUS FIVE (5) TOURNAMENT DEPOSIT OF ONE-HALF ENTRY FEE

($62.50 EACH TOURNAMENT), PLUS MEMBERSHIP OF $25/pp REQUIRED. The remaining balance of the

Tournament Entry Fee will be due on or before the Monday prior to each of the Friday Tournaments. A $20 late fee will be assessed if not received by that day.

CALCULATION: $25 per person ($50 Team) Membership + $125 First Tournament Entry Fee + One Half

Entry Fee Deposit ($62.50 x 5 = $312.50)
For The Remaining 5 Tournaments = $487.50

Optional Big Fish Pot is not included, nor is the Classic Entry Fee.

Or you may choose to pay the full amount for the regular season.

$800 per 2 person team or $775 for 1 person team.

Optional Big Fish Pot is not included, nor is the Classic Entry Fee.

PARTICIPANT WAIVER RELEASE OF LIABILITY - READ BEFORE SIGNING

As a condition and in consideration of being allowed to participate in the SBA Tournament(s) and all activities surrounding this fishing tournament for this season, (PLEASE PRINT)

l,_________________________________________________________________________, Boat Owner, and

l,_________________________________________________________________________, Partner,

do hereby acknowledge and agree as follows:

The undersigned acknowledge that there is a significant risk of injury from the activities involved in the Tournament(s) including the potential for permanent injury and death. The undersigned agree that they are knowingly and freely assuming all risks of participation in the Tournament(s) and assume full responsibility for their participation in the Tournament(s).

THE UNDERSIGNED BY AND FOR THEMSELVES AND THEIR HEIRS PERSONAL REPRESENTATIVES AND

NEXT OF KIN DO HEREBY RELEASE FROM ANY AND ALL LIABILITY SBA, ITS OFFICERS' OFFICIALS,

EMPLOYEES' AND ALL OTHER PARTICIPANTS IN THE TOURNAMENT(S), ALL SPONSORING AGENCIES

SPONSORS ADVERTISERS AND, IF APPLICABLE, THE OWNERS AND LESSORS OF THE PREMISES USED TO

CONDUCT THE TOURNAMENT(S) (COLLECTIVELY THE "RELEASEES"), WITH RESPECT TO ANY AND ALL

INJURY, DISABILITY, DEATH, LOSS OR DAMAGE TO PERSONAL PROPERTY INCURRED BY THE UNDERSIGNED

AS A RESULT OF PARTICIPATION IN THE TOURNAMENT(S) WHETHER ARISING FROM THE NEGLIGENCE OF

THE RELEASEES OR OTHERWISE. FURTHER, THE UNDERSIGNED AGREES TO HOLD HARMLESS AND

INDEMNIFY ALL RELEASEES FROM ANY AND ALL LOSS, COST DAMAGE OR EXPENSE INCLUDING

REASONABLE ATTORNEY'S FEES ARISING OUT OF THE UNDERSIGNED'S PARTICIPATION IN THE

TOURNAMENT(S).

The undersigned agree that they have read this Waiver and Release of Liability and the Rules and Regulations governing the Tournament(s) and fully understand their terms. The undersigned further agree that by signing this Waiver and Release of Liability they are giving up substantial rights and agree that they are doing so freely and voluntarily without coercion or inducement.

BOAT OWNER'S

SIGNATURE__________________________________________________________________DATE__________

PARTNER'S

SIGNATURE__________________________________________________________________DATE__________

MAKE CHECKS PAYABLE TO: SENIOR BASS ANGLERS

MAIL TO: SENIOR BASS ANGLERS

1066 Bradley Road

Gallatin, TN 37066

SPECIAL NOTE: A copy of your driver’s license, with photo, must accompany your Entry Form as Proof of Age to complete your membership unless it is already on file.