AZ Entry Form

Central Arizona Entry Form

Tournament Date: ______________
Lake Pleasant / Lake Alamo / Lake Pleasant / Lake Havasu / Lake Roosevelt
(1/19/2008) (2/23/2008) (4/19/2008) (5/17/2008) (6/14/2008)

Boater:
(Please print)

Name: ___________________________ SS#_____________________

Address: __________________________________________________

City: ________________________State_____ Zip code___________

Phone (____) ______________________e-mail___________________

Non Boater:

Name: ____________________________SS#_____________________

Address: __________________________________________________

City: ________________________State_____ Zip code___________

Phone (____) _____________________e-mail____________________

Mandatory		Options with 100% Payback *Must be in option to win option money
Entry	$135	*Top Gun (Winner Take All)	$20
Insurance	$ 10	*Red, White, & Blue	$20
Membership	$ 35	*Big Bass (pays top 3 big bass)	$30
Additional Family	$ 20	*Top 5 (pays top 5 in option)	$30
Total Mandatory $		Total Option $

Total Due $______________ Cash_____ Check # _________

I/we have completed this application and have submitted the total fees for participation in consideration for the privilege of participating in this tournament. I hereby release all tournament officials and sponsoring organizations from all claims of injury and/or damages incurred in connection with this event. I understand that I may be subject to a polygraph exam and that National Bass West Allstar Bass reserves the right to refuse entry and services to anyone. The tournament director’s decision is final. Please see the rules for further information. Please sign below for release.

______________________________ ____________________________
Boater Non-Boater