SENIOR BASS ANGLERS
2011 Entry Form
BOAT CAPTAIN:_____________________________________________________
ADDRESS:__________________________________________________________
CITY:__________________________________ STATE:______
ZIP:____________
SOCIAL
SECURITY#:________________________ EMAIL:___________________
HOME PHONE: (_____)__________________ CELL:(_____)_________________
BOAT USED:___________________________________________
YR:_______
MAKE OF MOTOR:____________________________________
HP:__________
HP
BOAT RATING: _________ TROLLING
MOTOR: ________________________
DID
YOU BUY YOUR BOAT FROM CLARK MARINE? ___YES ___NO
DID YOU BUY YOUR VEHICLE FROM CUNNINGHAM MOTORS? ___YES ___NO
Company Name, Policy # or Agent Binding
Coverage on boat to be used in Tournament
(see Rule #17)
INSURANCE COMPANY:______________________________________________
POLICY#: __________________________
AGENT:_________________________
TOW VEHICLE:_______________ MODEL: _________________ YEAR:_______
PARTNER NAME:____________________________________________________
ADDRESS:__________________________________________________________
CITY:_________________________________ STATE:______
ZIP:____________
SOCIAL
SECURITY#:_____________________________EMAIL:______________________
HOME PHONE:(_____)__________________
CELL:(_____)__________________
PROOF OF
AGE: Copy of valid drivers license or other form of identification must accompany this form.
PER TOURNAMENT ENTRY FEE: $125.00
PER BOAT (Big Fish Pot of $10 per person collected
at check-in.)
FIRST TOURNAMENT ENTRY FEE - $125.00, PLUS FIVE ADDITIONAL TOURNAMENT DEPOSIT OF ONE-HALF ENTRY FEE ($62.50 EACH TOURNAMENT)
REQUIRED: Priest, Guntersville, Old Hickory, Kentucky Lake, Lake Barkley,
and Old Hickory. The remaining balance of the Tournament Entry Fee will be due on or before
the Monday prior to each of the tournaments on Friday. A $20 late fee will be assessed if not received
by that date.
CALCULATION: $25 per person
($50 team) Membership + $125 First Tournament Entry Fee + One-half Entry Fee Deposit ($62.50
per tournament x 5) $312.50 For Remaining 5 Tournaments.
TOTAL:
$462.50 Individual or $487.50 Team
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 2007, (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
