Entry Form
Northeast Wyoming Walleye Association
Fall Club Tournament, September 18, 19 2010
First Team Member:
Name______________________________________________
Age:____________ Social Security Number:____________________________
Address: ________________________________________________________
City:__________________________ State:____________________________
Zip Code:________________ Phone Number:__________________________
Email Address: __________________________________________________
Second Team Member:
Name:__________________________________________
Age:___________ Social Security Number: ___________________________
Address: _______________________________________________________
City: ________________________ State: ____________________________
Zip Code: _______________ Phone Number: _________________________
Email Address: _________________________________________________
We have read and understand the Northeast Wyoming Walleye Association Tournament rules and regulations including Section 2, Release of Liability, and agree to the rules and conditions set forth therein.
X: ________________________________________ Date: ______________
Applicant= Signature
X__________________________________________ Date: _____________
Applicant= Signature
This entry form must be accompanied by payment of $175.00 pre team by September 10th, 2010 to:
Brian Mensing
PO Box 3304
Gillette, Wyoming 82717
Entry after September 10th is Cash or Money order. $175.00
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