Registration Form

DATE:____/____/____                                                                            ID #__________

FIELD OF DREAMS

CROTON BASS CHALLENGE 2010

REGISTRATION FORM

(PLEASE PRINT)

NAME:_____________________________________________          AGE:__________

ADDRESS:______________________________________________________________

CITY:___________________________          STATE:______          ZIP CODE:_______

PHONE #:________________________          EMAIL:___________________________

FEE: �  ADULT  $10.00          �  YOUTH (UNDER 16)  $5.00    

(PLEASE INCLUDE CASH, CHECK, MONEY ORDER)

LIABILITY RELEASE

By signing this application, I do hereby release all other contestants, sponsors and tournaments officials from any and all liability as to injury, damages, losses, etc. incurred at Croton Pond during this bass fishing tournament.

__________________________________________

                                  (Signature)        

SEND TO:

CROTON BASS CHALLENGE 2010

C/O CHARLIE ELLIOTT

PO BOX 234

HOWARD CITY, MI 49329