First Name:__________________________________________ Last Name:__________________________________________

Address:____________________________________________ City:________________________________________________

State:_______________________________________________ Zip Code:____________________________________________

Email:_______________________________________________ Phone:______________________________________________

Social Security #:_____________________________________ Date of Birth (mm/dd/yy):_______________________________

Non-Boater Fishing with Boater:

Name:________________________________________________

Entry Fee: $65.00 per person
Make Checks payable to:
Wish to Fish Foundation

I have read and understand the rules for this event. I have voluntarily completed this application and have included my entry fee to participate. I hereby agree to be bound by and comply with all tournament, Federal and state rules and regulations. I expressly assume all risk(s) for me and my partner that is associated with each tournament event.

______________________________________________________
Angler Signature must be signed to be VALID

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION):
This is to certify that I as parent/guardian with legal responsibility for this participant, do consent and agree to identify and hold harmless the Releases from any and all liability incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISIN FROM THE NEGLINESS OF THE RELEASEES to the fullest extent by the law.

______________________________________________________
Signature of Parent/Guardian of above minor

Check, Cash, Money Order, Credit Card ( Mastercard, Visa, Discover)

Credit Card #:__________-__________-__________-__________ Expiration Date:____/____ the 3 numbers on the back:_______

Signature:_____________________________________________
($7.50 handling fee per entry on credit card charges)