Captain Name *

One person must be a paid MBA member

First Name

Last Name

Captain Ph# *

(###)

###

####

Co-angler Name *

One person must be a paid MBA member

First Name

Last Name

Entry and Acknowledgment *

Having acquainted myself with the Rules and Regulations attached. I hereby submit my Entry Form for registration. By clicking this checkbox I accept the Rules and Regulations attached and I agree to abide by them. I also give my permission for the free use of my name and picture in broadcast, telecast or written accounts of this event.

I acknowledge

Waiver of Claim Release and Indemnification Agreement *

In consideration of the acceptance of my entry in the Falcon Lake Bass Classic, its promoters, employers, sponsors, organizers, hosts, directors, officers and all other organizers and affiliated organizations, agencies and/or agents and assignees and any other person assisting in this event from any claims for damages or injuries suffered by me as a result of my participation in or traveling to or from this event. I hereby state that I am in proper physical condition to participate in this event and am aware that participation could in some circumstances result in physical injury. I further agree to indemnify the Falcon Lake Bass Classic (mentioned above), from any claims or damages arising out of or in consequence of the participation or attendance by me in this event.
Important: If under the age of eighteen (18) this waiver of claim, release and indemnification agreement MUST be signed by a Parent or Legal Guardian.

I agree

Payment *

I understand my entry is not valid until the MBA receives payment of $200. I have all ready sent my payment, or i will send it immediately after completion of this form.

PLEASE SEND ENTRY FEE TO mbbassanglers@gmail.com

Payment Sent