Angler’s Name:
(Include your status in parentheses - Alumni, Faculty, Staff, Student, Parent, etc.)

Team Name:

Address:

City/State/Zip:

Phone:

E-Mail:

Additional Anglers:
(Limit Three Anglers per boat)

Name:

Address:

Name:

Address:

Please note quantity and sizes (Sizes L & XXL):
(One per Angler included-$12 per additional shirt)

Entry Fee
$250 per Angler (max 3 per boat)

or $750 per Boat

Visa / Mastercard / AMEX card #:

Expiration Date:

Total:

Name as listed on credit card:

Billing Address: