Team membership application-2009

BOATER NAME_________________________________________________

ADDRESS_____________________________________________________

CITY______________________________STATE_____ZIP___________

PHONE__________________________CELL___________________________

EMAIL_____________________________________________

Boater must be insured  INSURANCE CO.________________________________

POLICY#   ____________________________

TEAM PARTNER

NAME________________________________________________________________

ADDRESS____________________________________________________________

CITY_____________________________STATE_______ZIP___________________

PHONE_______________________CELL___________________________

EMAIL_____________________________________________

ANNUAL MEMBERSHIP $50.00 per person         DATE PD___________  $_________________

I have received a copy of the rules.  I will abide by all competition rules, size limits lake

Rules state and federal laws etc. I will operate my boat in a safe manor. I understand I

am completely responsible for my actions during any tournament and hold harmless

Tricountyanglers, their staff, and sponsors.

________________________________________________        Signature                                                                                Date

________________________________________________        Signature                                                                                Date