Team membership application 2012               

BOATER NAME_______________________________

ADDRESS___________________________________

CITY_______________STATE_____ZIP___________

EMAIL _____________________________________

PHONE____________________CELL_____________

TEAM PARTNER NAME________________________

ADDRESS____________________________________

CITY______________STATE_______ZIP___________

PHONE__________________CELL_____________________

EMAIL_____________________________________________

Boater must be insured: INSURANCE CO._________________

                             POLICY#   ____________________________

ANNUAL MEMBERSHIP 30.00 PER PERSON     DATE PAID_________

I have received a copy of the rules.  I will abide by all competition rules, size limits, lake

Rules, state and federal laws etc. I will operate my boat in a safe manner. I understand that I am responsible for my actions during any tournament and hold harmless Tri county anglers, their staff and sponsors.

________________________________________________                                                         Signature                                                                                                                Date

________________________________________________________________________

Signature partner                                                                                                        Date