Fall Brawl 2021 Entry Form

PRINT THIS PAGE AND FILL OUT
2021  FALL BRAWL KING CLASSIC

BOAT NAME:    ______________________________________  TOTAL ENGINE HP: _________

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):  ______________________________________________________________

Sr. Anglers (male 55+ years):  __________________________________________________________________

KINGFISH CUP PARTICIPANT?  YES _____   NO  ______  If YES, KFC #_______ 

BOAT LENGTH : ________  BOAT BRAND:  ______________  ENGINE BRAND:  ________________


DECLARE YOUR FISHING DAY

I CHOOSE TO COMPETE:   _________  SAT, Oct 23rd     _________SUN, Oct 24th   ________  WILL CALL TO DECLARE

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 2021 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:    _________________

ENTRY:    $325   _______       

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

"HIGH ROLLER'S" TWT":    $250    __________      "SMALL BOAT (300hp or less)" TWT:    $100   ____________

"LADY ANGLER" TWT: $100  ________          

 FILL OUT THE ENTRY FORM, PRINT IT, INCLUDE PAYMENT AND MAIL OR DROP OFF
Make checks payable to:  FBKC  -  1770 Twisted Oak Ln SW, Ocean Isle Beach, NC  28469

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