MAXIMUM 40 TEAMS
Entry Fee: $150.00 / team

Adult Name:____________________________________
Address:_______________________________________
City:________________Postal Code:________________
Phone #:_______________________________________
E-mail:_________________________________________
Signature:_____________________T-Shirt Size - M-L-XL-XXL

Youth Name:__________________Age:_______________
Address:________________________________________
City:________________Postal Code:_________________
Phone #:_______________________________________
E-mail:_________________________________________
Signature:________________________ T-Shirt Size - S-M-L-XL

Youth Name:_________________ Age:______________
Address:_______________________________________
City:_________________Postal Code:_______________
Phone #:_______________________________________
E-mail:_________________________________________
Signature:________________________ T-Shirt Size - S-M-L-XL

Make checks payable  to:
Culver Marina Inc.

Event Director Contact Info:
Gary Aker Sr.
Ph: 574-842-3375
Email: garyakersr@culvermarina.com

Participation release – Read before signing

• The risk of injury from the activities involved in this tournament is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of injury does exist: and
• I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participations; and
• I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazards during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and
• I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Angler & Young Angler, their officials, other participants, sponsoring agencies, sponsors, advertisers, and , if applicable owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILLITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
• As the adult angler of the team I take full responsibility for my partners, Young anglers, and have granted permission for him/her to fish this event as per the conditions of the waiver.