ENTRY FORM (for conventional mail or drop off)

Wallkill Rod and Gun Club and Marlboro Yacht Club

18th Annual Hudson River Striped Bass Tournament

May 14th & 15th, 2011

In consideration of being accepted as a participant in the Wallkill Rod and Gun Club and Marlboro Yacht Club Striped Bass Fishing Tournament, I hereby release and discharge the Wallkill Rod and Gun Club and the Marlboro Yacht club and their Officers, directors, agents, and employees from all claims, demands, or causes of action out of or resulting from any anticipated or unanticipated incident resulting from participation in the tournament. I understand that the contest sponsors assume no responsibility or liability for any boats entered or participating in the contest. I understand that the contest will be held rain or shine and that it is the sole responsibility of the captain of all entered boats to determine if the weather and river conditions are safe to fish. I recognize that the rules are posted on the website and I will print them out for my reference. I hereby state that I have read and understand all these rules, regulations, and disclaimers and agree to abide by them.

Name: __________________________________________________________________ Address: ________________________________________________________________ City: _________________________________ State:_________Zip Code:____________ Phone: (______) _________________________________ Age: ____________________ Email:___________________________________________________________________ Entrant's Signature: _______________________________________________________ Parent or Guardian's Signature:______________________________________________ If entrant is under 16 years old. Were you a tournament participant last year? (circle)    YES       NO

Entry fee is $30.00, ($20.00 under the age of 18) and must be submitted with a properly completed entry form. Entry forms accepted after May 12th will be considered late and thereby subject to a $35.00 entry fee. Entry fees are not refundable unless the director cancels the tournament. Tournament fishing starts at 12:00 A.M., Saturday, May 14th, and ends when the scales close at 5:00 P.M. Sunday, May 15th. For more information call Tournament Director: Tom Forstner (845) 744-5232 Make check payable to: Wallkill Rod and Gun Club then mail along with entry form to: