Maine Fishing Tournament - Agency 1 Real Estate in Southern Maine

REGISTRATION FORM

Please Print or Type:
(Please fill out separate entry form for each category entered)

Name_________________________________________
Address______________________________________
City_________________________State______Zip___
Phone___________(h)____________(w)_________(C)
Email ______________________________________
Boat Name___________________________________

Tournament Options- Please check one box.

Small Game	Big Game	Tuna	Full Package	12 & Under

Bluefish Stripers *Cod _____ $50	*Sharks ____ $100	*Tuna ____ $250	Full Package Bluefish Stripers Cod Sharks *Tuna ____ $325	12 & Under Mackerel Bluefish *Stripers ____ $20

Please make checks payable to:
Agency 1 Fundraising

I understand that my participation in the MDA and Agency 1 Sport Fishing Open is at my own risk and that I waive and release MDA, Agency 1, and all other persons, companies, and organizations connected with the operation of the tournament from any and all liability for bodily injury or any other loss or damages that may occur.

Signature_______________________Date_____
Parent/Guardian Consent________________________Date_______