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

Rules *

You commit to reading the rules and understanding them for this tournament and understand NOT following said rules will result in disqualification. Please note rules MAY change during the lead-up to the tournament. All anglers must be familiar with the rules including any changes made up to the event in which they apply.

I acknowledge

Waiver of Claim Release and Indemnification Agreement *

In consideration of the acceptance of my entry in the Nutimik Lake Bass Tournament, 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 MBA Bass Tournament (mentioned above), from any claims or damages arising out of or in consequence of the participation or attendance by me in this event.

I agree

Payment *

I understand my entry is not valid until the MBA receives payment of $300. 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