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REGISTRATION FORM: Please Print or Type.
(Please fill out separate entry form for each category entered).
Name____________________________________________________________
Address__________________________________________________________
City_________________________________State____________Zip__________
Phone (h)________________ (w)_________________ (c)_________________
Email ____________________________________________________________
Boat Name________________________________________________________
Tournament Options - Please check one box.
____ $ 20: 12 & Under (Mackerel, Bluefish, Stripers).
____ $ 50: Small Game (Bluefish, Stripers, Cod).
____ $100: Sharks.
____ $250: Tuna.
____ $325: Full Package (Bluefish,Striper,Cod,Shark,Tuna).
Please make checks payable to: Agency 1 Fundraising.
I understand that my participation in the MDA and Agency 1 Sport Fishing Open is at my own risk and that I waive and release MDA, Agency 1, and all other persons, companies, and organizations connected with the operation of the tournament from any and all liability for bodily injury or any other loss or damages that may occur.
Signature_________________________________________Date_________
Parent/Guardian Consent_______________________________Date_________
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