Please indicate Date of Tournament _________________________________________
Current Member:________YES _______ NO
My Membership Expires: ______________________
Non Members can join at lake or send $20.00 with entry
Name (1)_____________________________________________________________
Address _____________________________________________________________
City/State/Zip
________________________________________________________
Day-Time Telephone
__________________________ SS#_____________________________
Email Address:
_______________________________________________________ Age:____________
_____________________________________________________________
Type and Year of Boat
________________________________________________________
Type and Year of Motor ________________________________________________________
PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGMENT OF RISK
By signing you agree to abide by all the rules of the Pearl River Singles Circuit as well as any local, state and federal regulations. You waive the right to hold harmless the Pearl River Singles Circuit, the host, all sponsors and tournament officials from any and all claims, injury and/or damage incurred in connection with any Pearl River Singles Circuit events. You give the Pearl River Singles Circuit the right to use your name, any pictures that have your photographic likeness in them and/or voice for promotions, press releases and/or any other likeness. You shall not receive any royalties and/or other compensation in connection with such use. By signing this application you agree to submit to any truth verification testing upon the tournament directors request. Any suit brought against the Pearl River Singles Circuit will be brought in the state or county court, Pearl River County, Mississippi, where the principle office of the Pearl River Singles Circuit is located. If it becomes necessary for the Pearl River Singles Circuit to enforce these rules or someone on its behalf, you agree to pay the attorneys fees expended, or for which liability is incurred.
(1)__________________________________________
Signatures (Must be signed by contestants)
Parent, if minor__________________________________________________
| ______ We are current
members of Pearl River Singles Circuit |
|
| ______ We wish to join
Pearl River Singles Circuit |
$_________ |
| ______ Enclosed is our
Entry Fee (mailed 6 days prior to event) |
$_________ |
DATE OF EVENT:___________________________________
TOTAL
ENCLOSED $_______________
MAIL TO:
Pearl River Singles Circuit
Larry Mixon, Director
21068 Burt Rd, Bogalusa, LA 70427
(985)735-5408 or (985)516-7130
