Please print this form and bring to the tournament along with your entry fee. For more information, see "Entry Fee" under "Rules".

BOATER NUMBER ONE

Name: _________________________________

Address:_______________________________

City: __________________________________

State:_________ Zip: ___________

Phone: __________________________________

Email: ___________________________________

Signature: _______________________________

BOATER NUMBER TWO

Name:___________________________________

Address:_________________________________

City: ____________________________________

State:_________ Zip: ___________

Phone: __________________________________

Email: __________________________________

Signature:________________________________

Note:Bring the completed entry form with you to the Tournament.

Liability Release: By signing this Official Entry Form, I hereby release Seneca Rotary Club, Rotary International, Strickland Marine, Bountyland Enterprises their officers, sponsors, host, employees and anyone working in association with them from any damages, injuries or death that may occur as a results of competing in these events whether by negligence of the said parties or otherwise to the fullest extent of the law . I also submit to a polygraph upon any winnings or protest and fully submit to findings of polygraph as final. I certify I have read the rules and state that I have not failed a polygraph within the last 7 years.