TOURNAMENT FEE $100_______ *OPTIONALS~~BIG FISH POT $20_____TWT $40_____TOTAL PAID______________

PARTNER #1: (Print)__NAME_______________________________________________PHONE #_________________
ADDRESS______________________________________________________________Tobacco Affiliation__________________________
CITY, STATE, ZIP__________________________________________________________________________
EMAIL ADDRESS:_________________________________________________________________________

PARTNER #2: (Print)__NAME_______________________________________________PHONE #_________________
ADDRESS______________________________________________________________Tobacco Affiliation__________________________
CITY, STATE, ZIP_________________________________________________________________________
EMAIL ADDRESS:_________________________________________________________________________

Having read the rules concerning this tournament & signed this application for entry, I agree to waive & release the sponsors, other contestants, host marinas &
their agents, polygraphers & tournament staff of all claims of personal injury, property damage or loss thereof, loss of life or any other liability incurred by me or my
partner while participating in this event. I agree that the above statements are true & agree to take a polygraph test if requested & will accept the decision of the
polygraph operator & tournament director thereafter. I also have boat liability insurance, a current Fishing License, the current Boat Owners Registration & current
ID. Signing this release covers all 2020 Piedmont Bass Classics Events.

Partner #1 Sign:_______________________________________________________Date:________ Covers all 2020 PBC events.

Partner #2 Sign:_______________________________________________________Date:________ Covers all 202 PBC events.

YEAR MODEL & MAKE OF BOAT YOU ARE USING FOR THIS EVENT:___________________________OWNER____________________

Mail Entries To:  Phil McCarson....922 Valetta Rd....Durham, NC....27712--------Make Check or Money Order out to 'Phil McCarson'

Starting positions determined by time entries are received.  Flights determined by number of entries.   

Tournament Day Contact Phone Number:........ 919-971-5042 Cell
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