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FLORIDA DISABLED ANGLERS, INC. |
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BOATER First Name ________________ Initial _____ Last Name ___________________
Address
_____________________________ City_______________ State____ Zip _______
Phone #
(_____)____________________ Cell # (_____)____________
Pager # (_____)____________
E-Mail Address ____________________________________
Brand of Boat_______________
Color_____________ Registration #______________
Brand of Engine__________
Engine H.P. ______ Tow Vehicle _____________ Color_____
NON-BOATER
First Name _______________ Initial
_____ Last Name ___________________
Address
_____________________________ City_______________ State____ Zip _______
Phone #
(_____)____________________ Cell # (_____)____________
Pager # (_____)____________
E-Mail Address ____________________________________
Type of Disability
_____________________________________________________________
Special Remarks or Concerns:
__________________________________________________ *************************************************************************************************************
IN
THE EVENT OF AN EMERGENCY PLEASE NOTIFY
Name__________________________________________________________
Phone # (_____) ________ - _________ *************************************************************************************************************
Having
acquainted myself with the Rules and Regulations of Florida Disabled Anglers,
Inc., I have completed this Registration & Release form and submitted it for
my entry into the Florida Disabled Anglers’ Tournament Trail. In signing
this form, I hereby agree to be bound by and comply with all tournament rules
and regulations and the fishing laws and regulations of the state of Florida. I
expressly assume all risks associated with this Tournament Trail and hereby
release Florida Disabled Anglers, Inc., its Officers, Board of
Directors, Sponsors, and Tournament Officials from any and all liability,
claims of injury and / or damages incurred in connection with the Tournament
Trail. This signed release form applies for the entire year dated below and
covers all activities associated with Florida Disabled Anglers, Inc.
Please complete
this form, signed and dated, and bring it with you to your first tournament or |