KEYSTONE INVITATIONAL BENEFIT BASS TOURNAMENT
SATURDAY, NOVEMBER 15, 2003

ENTRY FORM:

Please type or print......(photocopies of this form are accepted)
____$60 Team Entry _____ $20 Optional Big Bass Pot

Amount Enclosed: $____________

Name of Captain:______________________________________________

Address____________________________________________________
City____________________________State_______Zip______________
SS#_____________________________Phone_____________________
Signature___________________________________ Date____________
Partner’s Name_______________________________________________
Address____________________________________________________
City____________________________State_______Zip______________
SS#_____________________________Phone_____________________
Signature___________________________________ Date____________
E-Mail Address:___________________________________

Having acquainted ourselves with the rules we have completed the application and are enclosing our total team fee. In signing this application, we hereby waive and release all other contestants, hosts, sponsors, and tournament officials from all claims, injuries, and/or damages incurred in connection with this event. We acknowledge that our personal safety and the safety of our property is our sole responsibility. We further understand and agree that the tournament official reserves the right to refund the entry fee if they should choose for any reason not to accept our application.


Make checks payable to:
Tulsa Firefighters Educational Clowns

Mail Entry Form and Payment to:
Brenda Leake
4530 South 289 West Ave.
Mannford Ok. 74044