Hospice Tournament Entry Form
Please read the tournament rules before signing up!
Mail to: Lance Valentine's Walleye 101/ PO Box 90318 / Burton MI 48509-0318
| Angler Name | Address | City, Zip | Shirt Size |
| Make and Model of Boat | |
| Color of Boat | |
| Team or Boat Name | |
| Team Captain |
| E-Mail of Team Contact Person | __________________________________________________________________ |
| Number of Anglers ___________ x $30.00 each | $ |
| Non-Angler Dinner Tickets ________ x $10.00 each | $ |
|
Total Due |
$ |
| Check #_____________________ for $____________ Made Payable to Lance Valentine's Walleye 101 | |
| Credit Card # ______________________________________________________ | Exp Date ___________________ |
| Card Holder Name __________________________________________________ |
V-Code ___________________ |
| Card Holder Signature ___________________________________________________________ |
****Each angler will receive a donation receipt from Hospice of Michigan in the amount of the entry fee****
****Cancellations based on weather/water conditions are the final decision of the Tournament Director. Cancellation will result in a random drawing for prizes. Due to the donation aspect of the event, entry fees will not be refunded if tournament is cancelled.
****NO ALCOHOL OR OTHER ILLEGAL SUBSTANCES ALLOWED AT ANY TOURNAMENT VENUE AT ANY TIME.
****By signing this form you agree to hold harmless “Lance Valentine’s Walleye 101 Inc.” and any and all promoters, agents, agencies, employees and organizations assisting or providing services for the operation of the trip. Furthermore, you agree to waive all responsibility for death, injuries, damages, liability, theft, fire or loss to person and/or equipment of any kind. No unsigned entry will be accepted. All anglers must sign this form before boat leaves harbor.
****All boats and equipment used in the tournament must be properly registered and insured.
I have read, understand and agree to the above listed terms and conditions concerning cancellation policy, release of liability and general rules of tournament I am attending. I have read all rules and regulations and agree to abide by them. I verify by signature that I have a valid 2008 Michigan fishing license or are not required by law to have one.
All anglers MUST sign below before leaving dock!
Signature_________________________________________ Date________________
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