Single Entry(s) Registration Form

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

***Incorrect mailing address will result in delay of receiving any tournament winnings via Canada Post***

Cell Phone(Required)

Email(Required)

Birthday(Required)

Boat insurance company name and policy #(Required)

Name(Required)

First Last

Phone(Required)

Emergency Email(Required)

Angler 1(Required)

First Last

Angler 2(Required)

First Last

Angler 2 Email(Required)

Angler 2 Phone(Required)

Tournaments(Required)

Full amount ($450 includes Big Fish) + tax + processing fee

Q3 Brockville July 12

Q4 Cornwall Aug 9

Q5 Cornwall Aug 10

Q6 Cardinal Aug 23

Tournaments total

Total

Absolutely no refunds

Credit Card

Card Details

Cardholder Name