BUGGS ISLAND TEAM TOURNAMENT
TOURNAMENT APPLICATION

(Official use only) DATE ___________________ TEAM NO. _________ BOAT NO. ___________

NAME _______________________________________		NAME _______________________________________
ADDRESS ___________________________________		ADDRESS ___________________________________
CITY _______________________ ST ____ ZIP________		CITY _______________________ ST ____ ZIP________
PH # (______) __________________		PH # (______) __________________
SS # _________ / _______ / __________ (required)		SS # _________ / _______ / __________ (required)
E-mail: _______________________________________		E-mail: _______________________________________
Membership No. __________		Membership No. __________
Membership Fee	$_______
Entry Fee	$_______
Late Fee	$_______
Big Fish	$_______
Total	$_______	A service charge of $35.00 for all returned checks.
Buggs Island Team Tournaments reserves the right to refuse any tournament entry.  Having read the rules of Buggs Island Team Tournaments, and signed this application, I agree to waive and release Buggs Island Team Tournaments of all claims of personal injury and property damage incurred by me while participating in this tournament. I also agree to take a polygraph/stress test if requested.
Signature ____________________________Date ______		Signature __________________________ Date ______

PRINTABLE PDF VERSION: Registration Form