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END OF DAY RE-ENTRY - TOP FIFTY PIKE SERIES

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<strong>TOP</strong> 50 // THE FASTEST GROWING <strong>SERIES</strong> IN ONTARIO20<br />

twelve<br />

CFGA VERMILLION LK<br />

SATUR<strong>DAY</strong> JUNE 16 TH 2012<br />

VERMILLION LAKE<br />

<strong>ENTRY</strong> FEE: $230<br />

CONTACT:<br />

Amy Nesbitt 705-497-4731 or 705-758-1422<br />

<strong>OF</strong>FICIAL <strong>ENTRY</strong> FORM - PLEASE PRINT CLEARLY, AND FILL IN ALL INFORMATION.<br />

Team Captain: __________________________________<br />

Address: _______________________________________<br />

City/Town: ______________________________________<br />

Postal Code: ____________________________________<br />

Phone #: _______________________________________<br />

Email:__________________________________________<br />

2nd Team Member: ______________________________<br />

Address: _______________________________________<br />

City/Town: ______________________________________<br />

Postal Code: ____________________________________<br />

Phone #: _______________________________________<br />

Email:__________________________________________<br />

I, the undersigned have read the rules and procedures<br />

concerning this event and will obey them. I also waive the<br />

host club, other competitors ,sponsors and tournament<br />

officials from all claims and injury and or damage incurred in<br />

connection with this event. By my signature I will follow and<br />

obey the rules procedures and waiver(s)<br />

________________________________________________<br />

Signature of Captain<br />

________________________________________________<br />

2nd Member Signature<br />

PLEASE MAKE <strong>ENTRY</strong> FEE PAYABLE TO:<br />

Chelmsford Fish and Game Association<br />

C/O Amy Nesbitt<br />

CFGA 61 King Street • Chelmsford, Ontario • P0M 1L0<br />

705-497-4731 or 705-758-1422<br />

No post-dated cheques, last minute entries cash only.

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