TOURNAMENT WILL BE 1 DAY

2010 Striped Bass Tournament Entry Form - Saturday, May 1st

In consideration of being permitted to participate in the 16th Annual 1-day Striped Bass Tournament,
I hereby release and discharge Certified Marine Service, Inc., their officers, employees and sponsors from
any and all claims, demands, or causes of action out of or resulting from any anticipated or unanticipated
incident resulting in my participation in the tournament. I hereby state that I have read and understand all
of these rules and regulations.

Entrants Name: _________________________________________________________________________

Address: _________________________________________________________________________

City: _____________________________State: ____________________Zip: ____________

Home Phone: _________________Work: ____________________Cell: _________________

Fishing from Boat (Y/N) :______Boat Name: _________________Fishing from shore Y/N): ___

Signature of Entrant :___________________________________________________

Date: _____________

E-mail address: _________________________________________

Mail Check or charge card information & form to:

$30.00 Entry Fee includes Barbecue & T-shirt

Certified Marine Service, Inc.
PO Box 237
Connelly, NY 12417

845-339-3060 Phone or 845-339-6183 Fax