2009 Michiana Walleye Assn Inc. Tournament entry form

TEAM MEMBER #1                                                                                                  TEAM MEMBER #2

Name: ____________________________________________________________Name: _____________________________________________________________
Address: __________________________________________________________ Address: ___________________________________________________________
City: State: Zip: _____________________________________________________ City: State: Zip: ______________________________________________________
Home phone: ______________________________________________________ Home phone: ________________________________________________________
Mobile Phone: _____________________________________________________ Mobile Phone: _______________________________________________________
Birth date: ___ _____________________________________________________ Birth date: __________________________________________________________
Email: ____________________________________________________________ Email: _____________________________________________________________

Circle Desire Tournaments:

Tournament #1 May, 9 Winona. Warsaw IN. time 6-2

Tournament #2 Aug, 1 Cedar Lake, Van Buren County. MI time 6-2

Tournament #3 Sept, 19 Big Turkey, Steuben. County. IN time7-3


Entry per tournament $50.00 ($55.00 if received after Tuesday night of the tournament week) _________
MWA membership Single $25.00 Family $40.00 (each participant must be a member) _________
Total: _________

All sections of form must be completed. SEND TO: Michiana Walleye Association
Payment must be enclosed. C/O Tournament Director
Failure will result in a returned application. 13040 Day Road
If you have any questions email them to: Mishawaka, IN 46545
jusjign@comcast.net

Photo and Video Release
We agree that photographs, film or video tape taken of us during the event may be used for commercial purposes by tournament organizers, sponsors, and news media without royalties or prior consent, unless specified in writing prior to the event.
Team Member # 1 Yes __ No __ Team Member # 2 Yes __ No __

Liability Release
In signing this agreement, I hereby release the Michiana Walleye Association INC., its officers, and employees, its sponsors and their agents (hereinafter referred to as MWA) from any and all damages, claims, demands, costs or expenses relating to injuries, death, damage, theft, fire or any loss of any persons or any property which I may sustain and/or which I may cause by reason or participating in or in connection with this tournament. I further release MWA, for all damages relating to adverse weather conditions while participating in or in connection with this tournament. I further release MWA, for all damages relating to adverse weather conditions while participating in this tournament. It is my responsibility to seek safety should adverse weather conditions occur (prior to, during or after the tournament). I signify by my signature that I have read the rules and I understand and agree that I must have the required Liability Insurance and Agree to the above Michiana Walleye Assn Inc. Tournament rules.

Signature:_____________________________ Signature:_____________________________

Today’s Date:__________________________ Today’s Date:__________________________

2009/All Rights Reserved – Michiana Walleye Association Inc. michianawalleye.org