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
___________ 1909 South Illinois Street __________$20.00 check here o
___________Belleville, IL 62220

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_____________


CONTESTANT ONE:
SS# _______________________Check If Alternate o

ALTERNATE FOR______________________________________________

NAME________________________________________________________

ADDRESS____________________________________________________

CITY_____________________________STATE_______ZIP____________

PHONE # ____________________________________________________

SIGNATURE__________________________________________________

CONTESTANT TWO: SS# __________________Check If Alternate o

ALTERNATE FOR______________________________________________

NAME_______________________________________________________

ADDRESS____________________________________________________

CITY_____________________________STATE_______ZIP___________

PHONE # ____________________________________________________

SIGNATURE__________________________________________________

All returned checks subject to $30.00 fee to F.O.C.A.S. and legal fees if necessary!

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.

B. COVENANT NOT TO SUE AND WAIVER OF SUBROGATION. I further agree that I will never sue The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., et al for damages on account of any injury, death or damage I suffer or cause whether known now or which may develop in the future. In the event The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., et al are sued because of my actions, I expressly agree to indemnify and hold The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S.,, et al harmless from any liability whatsoever, including court costs and attorney's fee, arising with respect to such actions. I understand that in waiving my rights to sue The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., et al I am also waiving the rights of recovery from The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., et al of my insurance carrier for any claims they may pay on my behalf.

C. VERIFICATION OF LIABILITY INSURANCE. I maintain a minimum of $100,000 liability insurance on the boat I will use in this tournament.

D. POLYGRAPH/VOICE STRESS TEST. Failure to take or pass the polygraph/voice stress examination will result in immediate disqualification without recourse. Random testing may be given at anytime by tournament Officials to any contestant, with or without protest being filed.

E. LIKENESS/PHOTO RELEASE: In consideration for permission to participate in the Tournament, I ("Contestant") hereby grant to The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., its assignees and/or licenses (collectively "Sponsors"), the unconditional right to use my name, voice, photographic likeness, biographical information, fishing tips and/or instructions in any medium whatsoever, including but not limited to video/audio productions, merchandising, promotions, articles, and/or press releases, in connection with The Federation Of Christian Anglers & Sportsmen Inc./F.O.C.A.S., and/or the The Federation Of Christian Anglers & Sportsmen/F.O.C.A.S. Tournament Trail, without restriction as to changes or alterations from time to time. I understand that I will not be entitled to receive any royalties or other compensation in connection with such use.

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.