2005
OFFICIAL ENTRY FORM
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MAIL TO P.O. BOX 86022, BATON ROUGE, LA, 70879
225-229-6351
ENTRY FEE- $300.00 PER TEAM
SEE SCHEDULE FOR PRE-REGISTRATION DEADLINES
DEPOSIT- $100.00 PER EVENT
$50.00 LATE FEE AFTER
SEPTEMBER 14, 2005
BIG TROUT POT ( OPTIONAL ) $50.00 PER TEAM
PLEASE CIRCLE EVENT CHOICES AND FILL OUT ALL REQUESTED INFORMATION
EVENT: LAKE CHARLES VENICE HOPEDALE
Check Cash Money order VISA/MASTERCARD
TEAM MEMBER 1
NAME__________________________________________
ADDRESS_________________________________________
_________________________________________
PHONE___________________________________________
TEAM MEMBER 2
NAME____________________________________________
ADDRESS_________________________________________
_________________________________________
PHONE___________________________________________
ALTERNATE
NAME_____________________________________________
ADDRESS____________________________________________
____________________________________________
PHONE______________________________________________
SIGNATURE___________________________________________
MEMBER 1
SIGNATURE____________________________________________
MEMBER 2
