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Boater

Name *

Address *

City *

State *

Zip *

Phone *

SS# *

Email *

Boat Year Make and Model *

Contingency Programs Signed Up For if none Write None *

Requested Flight *

Next

Co-Angler

Name *

Address *

City *

State *

Zip *

Phone *

Email *

SS# *

Boat Make and Model

Contingency Programs Signed Up For

Select One or More *

• Entry fee/Tournment - $ 130.00
• Angler Membership - $ 37.00
• Co-Angler Membership - $ 37.00
• Gadsden Super Tournament with Big Fish - $ 183.00
• Gadsden Super Tournament with out Big Fish - $ 162.00
• Lincoln Fire Department Tournament - $ 0.00

Total *

$ 0.00

Participation Agreement & Release

I have read the Participation Agreement & Release and Agree with all terms.

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