2008 MWA entry form

2008 Michiana Walleye Assn Inc. Tournament entry form

TEAM MEMBER #1 TEAM MEMBER #2

Name: _______________________________ Name: _______________________________

Address: _____________________________ Address: _____________________________

City: State: Zip: ________________________ City: State: Zip: ________________________

Home phone: _________________________ Home phone: _________________________

Mobile Phone: _________________________ Mobile Phone: _________________________

Birth date: ___ _________________________ Birth date: ____________________________

Email: ________________________________ Email: _______________________________

Circle Desire Tournaments:

Tournament #1 5/17/08 Winona 6am-2pm

Tournament #2 7/19/08 St Joe River Niles 6am-2pm

Tournament #3 9/13/08 Lake Maxinkuckee 6am-2pm

Entry per tournament $50.00 ($55.00 if received after Tuesday night of the tournament week) _________

MWA membership Single $25.00 Family $40.00 (each participant must be a member) _________

Total: _________

All sections of form must be completed. SEND TO: Michiana Walleye Association

Payment must be enclosed. C/O Tournament Director

Failure will result in a returned application. 13040 Day Road

If you have any questions email them to: Mishawaka, IN 46545

jusjign@comcast.net

Photo and Video Release
We agree that photographs, film or video tape taken of us during the event may be used for commercial purposes by tournament organizers, sponsors, and news media without royalties or prior consent, unless specified in writing prior to the event.

Team Member # 1 Yes __ No __ Team Member # 2 Yes __ No __

Liability Release
In signing this agreement, I hereby release the Michiana Walleye Association INC., its officers, and employees, its sponsors and their agents (hereinafter referred to as MWA) from any and all damages, claims, demands, costs or expenses relating to injuries, death, damage, theft, fire or any loss of any persons or any property which I may sustain and/or which I may cause by reason or participating in or in connection with this tournament. I further release MWA, for all damages relating to adverse weather conditions while participating in or in connection with this tournament. I further release MWA, for all damages relating to adverse weather conditions while participating in this tournament. It is my responsibility to seek safety should adverse weather conditions occur (prior to, during or after the tournament). I signify by my signature that I have read the rules and I understand and agree that I must have the required Liability Insurance and Agree to the above Michiana Walleye Assn Inc. Tournament rules.

Signature:_____________________________ Signature:_____________________________

Today’s Date:__________________________ Today’s Date:__________________________