Fishing Funament event you will be attending:

APPLICANT INFORMATION: Captain's name and information.

First Name:
Last Name:
Address:
Address 2:
City:
State:
Zip Code:
Day Phone:
Evening Phone:
Cell Phone:
Email:
Shirt Size:
Arriving By Boat?:
Miles Traveled:
Miles traveled to get to this event:
Boat Name:
Boat Year:
Boat Make:
Boat Model:
Boat Length:
Boat Serial Number:
Boat Status:
    Dealer Name: 
Motor Make:
Motor Model:
Motor Power:

CREW MEMBERS: All guests/crew of the boat captain MUST be registered here.

Total Number of Crew Members:

Crew Member 1

PAYMENT INFORMATION
Card Type:
Card Name:
Card Number:
Card CSV:  *The CSV number is the last three digits of numbers printed across the signature line on the back of your bank card.
Expiration Date:  
Event Fee: $100 per boat per event covering the entire crew (non-refundable)


COMMENTS


RELEASE OF LIABILITY: All signatories* to this document acknowledge that they recognize that there are inherent risks and dangers in any event involving boating and travel over water including weather conditions, sea conditions, unexpected obstacles, dangers from other boaters, and other known and unknown hazards. We hereby fully release, indemnify, and hold harmless Outdoor Associates, Bass Pro Shops, World Wide Sportsman, Fish Tale Marina and George Poveromo and GP Productions, Inc., who are the sponsors of this event, from any and all liability for injuries and damages that might occur to us during this event. This includes any responsibility of the sponsors for making decisions regarding whether or not to travel or fish on any given date during the event, and the signatories recognize they must exercise their own judgment based on their own equipment and abilities regarding whether or not to participate in any activity during this event.

*parent or guardian must sign for any minor entrant under 18 years of age.

AUTHORIZATION, TRANSFER OF OWNERSHIP AND RELEASE: The below-named individual(s) (“Individual”) hereby authorizes Bass Pro Trademarks, L.L.C., a Missouri limited liability company, at 2500 East Kearney, Springfield, Missouri 65898 (“Company”) to use any pictures, photographs, drawings, sketches and/or likenesses (“Items”) s/he gives to Company as follows: EXCLUSIVE RIGHTS. Individual shall permit Company the exclusive right to own and use the Item(s) given to, taken by or made by Company in any advertising, including but not limited to print, Internet, catalog, newspaper and/or lifestyle advertisements; provided, however, the Item(s) shall be solely for use in Company’s business advertisements and that the Items(s) shall not be transferred to any business not related to the sale of outdoor gear. Individual releases and discharges any and all rights s/he may have in and to said Item(s) and acknowledges that Company is the absolute owner thereof, and that Individual has no future rights therein. Individual authorizes Company to use Individual’s name, no name, or a fictitious name with the Item(s). Individual acknowledges that s/he is not entitled to compensation for the use of said Item(s) or his/her name or any rights Individual may have therein. INDEMNIFICATION. INDIVIDUAL AGREES TO INDEMNIFY AND HOLD HARMLESS COMPANY AND ITS AFFILIATES FROM LIABILITIES, SETTLEMENTS, EXPENSES AND COSTS, INCLUDING REASONABLE ATTORNEYS’ FEES INCURRED IN CONNECTION WITH ITS USE OF THE ITEM(S). THIS AGREEMENT SHALL CONTINUE IN FULL FORCE AND EFFECT NOTWITHSTANDING THE TERMINATION OF THIS AGREEMENT, FOR ONE HUNDREED (100) YEARS. POWER. Individual represents that s/he is of lawful age and that s/he owns the Item(s) and has all requisite power to enter into this Agreement and transfer such interest.

APPLICABLE LAW, JURISDICITION, VENUE. This Agreement shall be construed and governed by the laws of the State of Missouri. Jurisdiction and venue for all disputes connected with this contract shall be proper in the county or district in which Company is located.



Applicant and guest(s)/crew of applicant must sign the release of liability document upon arrival at event.