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Playground Area Kiwanis
Family Charity Fishing Tournament
19 and 20 June, 2010
Entry Form
______Senior Angler ($25)
______Junior Angler (under 16, $10)
_______Family ($40)
Name:_________________________________________________________________
Address:__________________________________________State______Zip________
Phone:_______________________ Email:____________________________________
If Family Entry, Names of Family
Members_______________________________________________________________
I/we waive/release all persons associated with the Kiwanis Family Charity Fishing Tournament
from all claims of injury and/or damage incurred in connection with this tournament. I/we give
permission to use my/our name(s) and image(s) for advertising and promotions. Personal
details to be used for entry validation only. They will not be shared with any other
organizations or entities
Signature:________________________________________________Date:_________
Make Checks Payable to Playground Kiwanis, mail the completed form to :
Playground Kiwanis
c/o New York Life
PO Box 448
Shalimar, FL 32579
Or
Entries will also be accepted at West Marine (FWB and Destin), The Original Waterfront
Crab Shack and Marina (FWB) and Half Hitch Bait and Tackle (Destin) See rules for
additional details.
Entry must be received no later than June 17th, 2010.Proof of Entry will be mailed or emailed
to you or be available for pick up at the weigh in.
If you cannot print this form, or have questions, please call Rich Gasparian at 609-1148 or
CLICK HERE to email your question