PRINT THIS PAGE AND FILL OUT
2010  FALL BRAWL KING CLASSIC
ENTRY FORM

BOAT NAME:    _________________________________________BOAT LENGTH: _________

CAPTAIN'S NAME:    _____________________________________

ADDRESS:    ________________________________________________________________

CITY:    _____________________________    STATE:    ___________    ZIP:    ___________

PHONE:    __________________________   

 S.S.#    ______________________________ (required)

EMAIL ADDRESS:    _________________________________ (required)

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

Lady Anglers(female & over 17yrs):  _______________________________________________

Senior Anglers(male & 55yrs+):  _______________________________________


DECLARE YOUR FISHING DAY

I CHOOSE TO COMPETE:

_____  SAT, Oct 23          ______  SUN, Oct 24

I CHOOSE TO REPRESENT:

_____ NC          _____ SC

_________________________ SIGNATURE  ________________ DATE

WAIVER CONTRACT:
I understand that I as registrant/captain/boat owner, am responsible for my boat
and occupants at all times.  I have read and fully understand and agree to abide
by all rules of the 2010 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 10/15/10    __________                                
ENTRY:    $250 after    __________                                                        
TWT:    $100   _______________
"HIGH ROLLER'S" TWT:    $250    __________         
"23 and under" TWT:    $100  _____________

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