Partner #1: |
Name: ____________________________________________________
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Address: __________________________________________________
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City: _____________________________________________________
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State & Zip: ____________________________________________________
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Phone: ___________________________________________________
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SSN#: ____________________________________________________
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E-Mail: ____________________________________________________
Lodging during event: _______________________________________
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Partner #2: |
Name: ____________________________________________________
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Address: __________________________________________________
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City: _____________________________________________________
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State & Zip: ____________________________________________________
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Phone: ___________________________________________________
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SSN#: ____________________________________________________
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E-Mail: ___________________________________________________
Lodging during event: _______________________________________
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Boat Information: |
Boat Brand & Length: _________________________________________________
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Engine Make & HP: _________________________________________________
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Payment Information:
Additional $10.00 handling fee for credit card charges |
Method of Payment: __________________________________________
____ Check ___ Credit Card on file ____ Call Office @ 281-852-8842 or mail to:
Anglers Quest 18923 Keyturn Ln Humble, Tx 77346
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RELEASE & WAIVER
In return for being allowed to participate in this contest, I expressly release and agree to hold harmless the sponsors, officers, employees, agents and affiliates from any and all claims as result of personal injury, property damages, accidents or illnesses (including claims caused in whole or in part by the negligence of the sponsor) that I may suffer which may arise during the course of or in connection with this Tournament. I further expressly assume the risk of any personal injury, property damages, or any other damages of any nature, which I may sustain in connection with my participation in this contest. I also release to A/Q the use and reproduction of any and all photographs and pictures taken during this event. I have read and understand the rules regulating this tournament. I also understand that cheating in this tournament is a punishable felony under current State statutes. Sponsors are defined as Anglers Quest, and any others supporting this event. Signature 1: _________________________________________________________________ Signature 2: _________________________________________________________________
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Please Print this Entry Form and
Mail Entries & Checks to:
ANGLERS QUEST
18923 Keyturn Ln
Humble,Tx 77346
PH. 281-852-8842
OR FAX 281-852-8662 |
