Membership Application

Please Print and Complete this form and Bring to one of the 1st two tournaments. (Jan or Feb.)

Crackerboys Application

ANGLER 1

NAME: ____________________________________________________________________

ADDRESS: _________________________________________________________________

CITY: ___________________________________ ZIP: ________________________

PHONES: HOME: _______________________ WORK: ____________________

CELL: _______________________ FAX: ______________________

SIGNATURE: ______________________________________________________

ANGLER 2

NAME: ____________________________________________________________________

ADDRESS: _________________________________________________________________

CITY: ___________________________________ ZIP: ________________________

PHONES: HOME: _______________________ WORK: ____________________

CELL: _______________________ FAX: ______________________

 SIGNATURE: __________________________________________________

ALTERNATE

NAME: ____________________________________________________________________

ADDRESS: _________________________________________________________________

CITY: ___________________________________ ZIP: ________________________

PHONES: HOME: _______________________ WORK: ____________________

CELL: _______________________ FAX: ______________________

In signing this entry form, I/we hereby agree and acknowledge that, if I/we claim any prize payable by the bass tournament, I/we are subject to a requirement to submit to and pass a polygraph test. I/we understand that prize claimants shall be subjected randomly for polygraph testing at the sole discretion of the tournament director. I/we further understand and agree that my/our failure to pass such polygraph test shall cause my/our disqualification from eligibility to collect any prize payable by Cracker Boy’s Bass Club. In signing this entry form, I/we wave and release all sponsors, host and tournament officials from any and all claims of injury, theft or damage resulting from a Cracker Boy’s Club bass Tournament.

MEMBERSHIP WILL BE $15.00 PER PERSON, $30.00 PER TEAM /  FIRST TOURNAMENT $110.00 INCLUDES MEMBERSHIP FEE
TOURNAMENTS THEREAFTER $80.00 ($60.00 TOURNAMENT + $20.00 BIG BASS)
SEND ENTRY FORM AND FEES MADE OUT TO: CRACKERBOY"S BASS CLUB 8302 N. 40TH STREET TAMPA, FLORIDA 33604