Delta-Brannon Island

Tournament Date:  _____________

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____________________

all in is $300 as itemized below Mandatory	Options 100% payback
Entry                  $160 Insurance             $10 Event Fee              $5  Membership        $35 Additional family  $20	*Top Gun (winner takes all)    $30 *Red, White, Blue (winner each flight)  $20 *Big Bass (pays top 3 big bass)   $30 *Mystery Weight (must be present to win) $15 *Top 5 (pays top 5 in option)    $30 *must be in option to win option money

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 must carry my own personal insurance for my boat and the anglers in it. I understand that I may be subject to a polygraph exam and that National Bass West, Inc. reserves that right to refuse entry and services to anyone. Tournament Director’s decision is final. Please see the rules for further information.   Please sign below for release

__________________________   ________________________
Boater                                             Non-boater