Tournament Entry Fees:

Boat Entry (Includes 4 anglers and 4 social tickets). Paid on or before Feb. 15, 2011

$1,000

Late registration paid after Feb. 15, 2011

$250

$

Total Fees:

$

*Required

Team / Boat Information:

*Team/Boat Name:

Pro-Am, as defined in rules:

Yes No

Yes No

Captain's Name:

Mate's Name:

Angler A: (Boat owner if applicable)

*Name:

Address:

City:

State:

Zip:

Phone:

Cell:

*Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB:

My signature below acknowledges that I, and all other anglers, have read the rules and will abide by them and that I, or any other angler in my crew, will voluntarily submit to polygraph examination at the request of CBLBC offcials.

Signature:

Angler B:

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB:

Angler C:

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB:

Angler D:

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB:

Angler E:

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB:

Angler F:

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Gender:

M F

Jr. Angler:

Yes No

If Jr., DOB: