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2007WRL Membership Registration and TeamTournament Entry Form

Registration is permitted the morning of an event, however a $10.00 late fee is charged on entries not received by Thursday.

Today’s Date:___/___/___     Region:_____________     Lake:_____________  Event Date:___/___/___

Boat Make:__________         HP:_________                 Motor:_____________ Troll Motor:______________

 Boater:                                                                        Non Boater:
 Name:___________________________________                Name:____________________________________________

 Address:_________________________________                Address:__________________________________________

 City, St, Zip______________________________                City, St, Zip:______________________________________

 Phone(___)____________SSN:______________                  Phone(___)_________________SSN:___________________

 Email_______________________________________   _____  Email____________________________________________

Membership: (  ) Individual $40 (  ) ___________________________________________________                $___________

Entry Fee: Regular Teams Future-Pro ($80)______________________________________________                $___________

Big Fish: ($20)_____________________________________________________________________                $___________

$10 Option________________________________________________________________________                $___________

$20 Option________________________________________________________________________                $___________

$30 Option________________________________________________________________________                $___________

$5 Insurance Fee (mandatory)_________________________________________________________                 $____________

Late Fee: ($10)_____________________________________________________________________                $___________

                                                                                                                 Total Due                         $___________

                Make Checks Payable to 100% BASS – P.O. Box 2583 Grass Valley, Ca.  95945  -  (530)-274-1397
I have completed this application and have submitted the total fees needed for participation.  In consideration for the privilege of participating in this tournament, I hereby release all tournament officials and sponsoring organizations form 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 waive all legal rights to challenge to results of said exam.  100% BASS reserves the right to refuse entry to anyone attempting to enter this event.

                                Please sign below for release of liability and polygraph waiver 

Boater:_______________________  Date:___/___/___      Non Boater:_______________________  Date:___/___/___