OFFICIAL ENTRY FORM For Northern and Central Divisions (Membership Required) Division ___________________________________________ Tournament ________________________________________ Date ______________________________________________ MARK AN “X” BESIDE NAME IF SUBSITUTE. Boat Owner Name ___________________________________’ Social Security No. ___________________________________ Address ____________________________________________ City, State, Zip ______________________________________ Phone ( ) _________________________________________ Boat & Model No. ___________________________________ Boat Length ____________________ HP _________________ (Partner’s) Name ____________________________________’ Social Security No. __________________________________ Address ___________________________________________ City, State, Zip ______________________________________ Phone ( ) _________________________________________ 1. Having read the official Salmoides, Inc. Tournament Rules and completed the above entry form, we agree to abide by all conditions stated therein. We, the signees, also agree to assume all applicable taxes. 2. Liability Release: In signing this agreement, we hereby release Salmoides, Inc., Its officers, agents, employees and sponsors from any and all damages, claims, demands, costs or expenses relating to injury of any persons or any property which we may sustain or which we may cause by reason of participation in or in connection with this Tournament. 3. Verification of Liability Insurance: We, the signees, further state that we maintain current liability insurance on the boat we will use in the tournament. 4. We signify by our signatures below that we have read and understand the agreements, numbered 1, 2 and 3 above. _________________________________________________ BOAT OWNERS SIGNATURE _________________________________________________ PARTNER’S SIGNATURE Must be signed by both Contestant(s) ENTRY FEES $150 for Northern and Central Divisions BIG BASS INCLUDED $25 MEMBERSHIP PER PERSON IS REQUIRED MAKE CHECKS AND MONEY ORDERS PAYABLE TO: SALMOIDES, INC. 18617 St. Rt. 190, Fort Jennings, OH 45844

DOUBLE DRAW Sign up for all five qualifying tournaments in the Northern or Central division and your team may draw two (2) numbers for boat position and use the one of your choice at that tournament. NOTICE! If your team signs up for the Double Draw, please read and sign your names. By signing our names this team understands that we will not be required to sign another release for the remainder of the calendar year. We also understand that by signing, it serves as a release of liability, covenant not to sue and waiver of subrogation for all tournaments for the remainder of the current calendar year and to abide by all rules and requirements. Signed by: 1st Team Member _________________________________________ 2nd Team Member ___________________________________________ For more information call ARNOLD OSTING 419-286-2897 BILL BAXTER 419-339-4882 www.ohiobassangler.com salmoides@hotmail.com SALMOIDES IS A NON-PROFIT ORGANIZATION