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I CERTIFY THAT THE SOCIAL SECURITY NUMBER SUBMITTED IS CORRECT AND THAT I AM NOT SUBJECT TO BACK-UP WITHHOLDING TAX. You must sign a release form before each tournament. MAIL TO:__F.O.C.A.S. ___________________One
Time Member open Fee Please Check If Spouseo If Child o Childs Age______________ Registration Amount___________________Big Bass _______________ MasterCard oVisa o American Express o TOTAL_____________ Card#_________________________________Expiration____________ LAKE______________________DATE OF TOURNAMENT__________
ALTERNATE FOR____________________________________________ NAME______________________________________________________ ADDRESS___________________________________________________ SIGNATURE_________________________________________________
CONTESTANT TWO: SS# __________________Check If Alternate o ALTERNATE FOR____________________________________________ NAME______________________________________________________ ADDRESS___________________________________________________ SIGNATURE_________________________________________________ All returned checks subject to $30.00 fee to F.O.C.A.S. and legal fees if necessary! |
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Read the tournaments rules before continuing. A. LIABILITY RELEASE.
In signing this agreement, I hereby release The Federation Of Christian
Anglers & Sportsmen
Inc./F.O.C.A.S., its officers, agents, employees and sponsors (herein referred
to as, The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S.,
et al) from all damages, claims, demands, costs or expenses relating to
injury of any persons or any property which I may sustain or which I may
cause by reason of participating in or in connection with this tournament.
I understand that by participating in this tournament that I may cause
or sustain injury including but not limited to: loss of life, loss of limbs,
paralysis, coma, loss of mental functions, loss of sight, loss of speech/smell,
dehydration, exposure, hypothermia, frostbite, sun stroke and all other
injuries that may be caused in a boating accident and/or exposure to the
elements. I further release The Federation Of Christian Anglers & Sportsmen
Inc./F.O.C.A.S., et al for all damages relating to adverse weather conditions
while participating in this tournament. It is my responsibility to seek
safety should adverse and/or unforeseen weather conditions occur prior
to, during or after the tournament. F. I SIGNIFY by
my signature that I have read all tournament rules and this liability
release and agree to abide by all rules, regulations, releases
and tournament official's decisions. |