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OFFICIAL ENTRY FORM/THIS IS
AN INDIVIDUAL TOURNAMENT
DATE___________ DO YOU HAVE
A TEXAS FISHING LICENSE: YES OR NO
Name (Print Clearly) ________________________________________ E-MAIL________________________
Address____________________________________________City_____________
Zip__________
Phone___________________________ Cell____________________
ENTRY FEE $30.00 Big Bass Pot $5.00 □
Yes □ No Total Paid__________
Number of Fish______ Big Bass Weight_________Total Weight___________Inital____
MAIL EARLY ENTRY FORM TO: BURLESON BASS CLUB, P.O.
BOX 1731 BURLESON TEXAS 76097, MUST BE POSTMARKED NLT: SEPT 13, 2010
In signing this application, I hereby
waive and release all other contestants, the Host, sponsors and
tournament officials from all claims or injury
and or damage incurred in connection with this
tournament. I further understand and agree that the tournament directors
reserve the right to refund this
entrance fee if they choose for any reason not to accept my application. I have
acquainted myself
with the rules and agree to abide by them. By signing this application I agree that should
I be asked to
do so, I will submit to a polygraph test.
SIGNATURE______________________________________________
As
a parent or guardian of named youth 15 years or younger, I hereby consent to his or her entering this
tournament. The
youth and I will abide by the rules and regulations that are listed above. By signing this
application I agree that
should my youth be a winner, said youth will have my permission to submit to a
polygraph test.
Guardian’s Signature______________________________Relationship____________________
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