2009 Spring/Summer Team Entry Form
(Please Print)
Team Captain:
Address: ____________________City State: ____Zip: _______
Phone: __________________________ Email:
Team Partner:
Address: ____________________City State: ____Zip: _______
Phone: __________________________ Email:
Sponsors:___________________________________________________________
LAKE / LAKES:
IN SIGNING THIS ENTRY FORM, I hereby release all other contestants, tournament officials, host, and sponsors from any and all damages, claims, demands, expenses and liabilities relating to or resulting from this tournament, including personal injury and/or property damage. I further agree that I will not sue or make any claim against any individual or group involved with this tournament now or in the future concerning any damage or injury relating to this tournament. In the event Backyard Bassin or its officials are involved in a lawsuit resulting from my actions, intentional or accidental, I hereby agree to indemnity and hold Backyard Bassin and its officials and/or employees harmless from any liability whatsoever. This release will also serve as notice that my insurance carrier will not sue or make any claims against Backyard Bassin, its officials and/or employees for any claims that may be paid on my behalf.
I HEREBY CERTIFY BY MY SIGNATURE on this form that I have read and understand the rules and regulations concerning this tournament. Any misunderstanding or untruthful statement made by me is my personal responsibility and I will hold Backyard Bassin and its officials, sponsors and/or employees harmless.
Signature: ____________________ Social Security Number: ______
Signature: ____________________ Social Security Number: ______
MAIL COMPLETED FORM WITH MEMBERSHIP AND ENTRY FEES TO:
Backyard Bassin 508 Campbell St. Ardmore, OK 73401
(580)220-8138 or (580)276-7765