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2009 California Team Tour - Tournament Entry Form

Boat Make:____________________________ Motor Make: _____________________________

Horsepower_______________ Troll Motor:_________________________ Electronics:____________________

Boater Name:___________________________________________________________

Address:______________________________________________________________________

City, St, Zip___________________________________________________________________

Phone(_____)_____________________________SSN:________________________________

Email Address: ________________________________________________________________

Partner Name: __________________________________________________________

Address:______________________________________________________________________

City, St, Zip___________________________________________________________________

Phone(_____)____________________________SSN:_________________________________

Email Address: _______________________________________________________________

 

Deposit Fee: ($250) number of events _____                   Total Due $__________

Entry Fee: ($1000) number of events_____                      Total Due $__________

Membership ($40 per person) ____________________ Total Due $__________

Circle event   Clear Lake – McClure – Shasta – Oroville – Delta
                                                                                       Grand Total $__________

Make Checks Payable to 100% BASS – P.O. Box 4112 San Leandro, Ca. 94579 - (469)-398-8502
I have completed this application and have submitted the total fees needed for participation. In consideration for the privilege of participating in these tournaments, 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 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:___/___/___

Please list your sponsor (optional)

_________________________ _________________________ _________________________

_________________________ _________________________ _________________________

_________________________ _________________________ _________________________

_________________________ _________________________ _________________________