Fall Brawl 2016 Entry Form

PRINT THIS PAGE AND FILL OUT
2016  FALL BRAWL KING CLASSIC

BOAT NAME:    _________________________________________

BOAT LENGTH (LOA from furthest point of bow to furthest point of stern): _________

# OF ENGINE(s):  _________________      TOTAL HP OF COMBINED ENGINE(s):  ___________

CAPTAIN'S NAME:    _____________________________________

ADDRESS:    ________________________________________________________________

CITY:    _____________________________    STATE:    ___________    ZIP:    ___________

CELL PHONE:    __________________________   EMAIL ADDRESS:   ___________________________ (required)

 S.S.#    ______________________________ (required)

Jr. Anglers(16yrs and younger) and age(s):_________________________________________________________

Lady Anglers(female & over 17yrs):  ______________________________________________________________

DECLARE YOUR FISHING DAY

I CHOOSE TO COMPETE:   _________  SAT, Oct 8th          __________  SUN, Oct 9th

WAIVER CONTRACT:
I understand that I as registrant/captain/boat owner, am responsible for my boat
and occupants at all times.   I further acknowledge that the boat in which I am participating has or will have liability insurance coverage in place at the time of this event.   I have read and fully understand and agree to abide
by all rules of the 2016 Fall Brawl King Classic.  I hereby release the Fall Brawl
King Classic, its sponsors, their principles, theirs subsidiaries, and their affiliates
from any and all liability.  I further understand that the decision to fish and participate
 is the responsibility of the registrant/captain/boat owner.

SIGNATURE:    ____________________________________    DATE:    _________________

EARLY ENTRY:    $215 BY 10/3/16   _______     ENTRY: $250 after _______    

                                               
"BIG FISH" TWT:    $100   _______________ "WHALE" TWT:  $500  ____________

"HIGH ROLLER'S" TWT":    $250    __________     "SMALL BOAT CLASS" TWT:    $100   ____________

"SINGLE ENGINE" TWT:  $100  _______  "LADY ANGLER" TWT: $50  ________ "COBIA" TWT:  $50 _______           

 

FILL OUT THE ENTRY FORM, PRINT IT, INCLUDE PAYMENT AND MAIL TO TOURNAMENT HEADQUARTERS
Make checks payable to:  FBKC  -  P.O. Box 895   -  Shallotte, NC  28459

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