Coulee Playland Open - Entry
Form
Captain
Name:
________________________________________________________________
Address:
____________________________________________________________________
City:
______________________________State: _______________Zip: _________________
If
you would like an email acknowledgement that your entry fee has been received
provide your email
address: ___________________________________________________________________
Partner
Name:
________________________________________________________________
Address:
____________________________________________________________________
City: _____________________________State: ________________Zip:
________________
|
I/We have read, understood, and agree to abide by all rules and regulations associated with the Coulee Playland Open and hold harmless all sponsors volunteers and tournament officials from any and all claims for injury or damages. |
Signed
Captain:____________________________________
Date:______________________
Signed
Partner:____________________________________
Date:______________________
(parent
must sign if either contestant is under eighteen)
Please make checks payable to The Banks Lake Bass Club
For information call:
Tom Melowitz 509 631-0934 or 509 633-2282
Tom_Melowitz@yahoo.com
_____________________________________________________________________
MAIL
TO:
Tom Melowitz
335 Mead Ave
Grand Coulee, WA 99133