Membership Application Form

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CAMP BLANDING ROD AND GUN CLUB
2012 CHARITY BASS TOURNAMENT APPLICATION

I hereby apply to the Camp Blanding Rod and Gun Club, Inc. to activly participate as a BOATER in the 2012 CHARITY BASS TOURNAMENT. I understand:

1. The Camp Blanding Rod & Gun Club, Inc. Board of Directors will govern the Tournament in accordance with advertised Tournament Rules.

2. That I am responsible to abide by all Safety Regulations pertaining to Rod & Gun Club activities.

3. I may elect to fish any of 4 lakes, based on my stated priority and date my application is received by the Club Secretary.

4. That winner payout will be based on the number of boats entered (less 20% to cover event expenses) and paid to 12 places, 1st, 2nd and 3rd place for each lake.

5. Big Bass Pot is optional and paid 100% to a single winner.

6. Purpose of the Tournament is to provide financial support to the Florida Youth Challenge Program and the Florida National Guard Foundation. More information can be found on their individual websites.

WAIVER OF LIABILITY:
As a participants of this Tournament I hereby agree to give up, relinquish, and to waive any and all claims for damages to which I may be entitled as a result of my presence on Camp Blanding including but not limited to any claims arising as a result of my fishing in any lake or hunting in any area on the post of Camp Blanding. I accept the above waiver and fully understand that if I am injured on the post of Camp Blanding that Camp Blanding or the Camp Blanding Rod & Gun Club inc. will not be held liabile for my injuries. I am fully aware of the safety regulations and requirements of the post of Camp Blanding and the possibility of unexploded ordinance in the lakes and hunting areas. I assume the risk of injury that may occur from the ordinance, which may presently exist in the area.

AKNOWLEDGEMENT AND ELECTRONIC SIGNATURE

I AGREE I DISAGREE

BOATERS NAME - LAST, FIRST

NON-BOATER NAME - LAST, FIRST

Lake Priority # 1

Lake Priority # 2

Lake Priority # 3

E-MAIL ADDRESS (required)

HOME ADDRESS

HOME PHONE

MOBILE PHONE

LAST UNIT OF ASSIGNMENT

CHECKOUT INSTRUCTIONS:

This is a 2 part process.
1. Submit Application
2. Pay Entry Fees.

1.Click the "SUBMIT APPLICATION" button below to send your application to the Secretary.

2. Complete the drop down forms and click the "Add to Cart" button. You'll be re-directed to Pay Pal where you can pay via credit / debit card.

3. Once complete, you will be re-directed back to the Camp Blanding Rod-Gun Club Website.

BOATER ENTRY FEES / BIG BASS POT