END OF DAY RE-ENTRY - TOP FIFTY PIKE SERIES
END OF DAY RE-ENTRY - TOP FIFTY PIKE SERIES
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 />
PROVINCIAL CLASSIC<br />
SATUR<strong>DAY</strong> SEPTEMBER 8 TH 2012<br />
LOCATION TBA IN ELK LAKE<br />
Potential sites for the 2012 classic will be Parry Sound,<br />
St. Charles (west arm) or Elk lake.<br />
<strong>ENTRY</strong> FEE: $220<br />
CONTACT:<br />
Jim Patry 705.855.4205<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 />
<strong>TOP</strong>50<br />
96 Vaillancourt Crescent • Chelmsford, ON • P0M 1L0<br />
No post-dated cheques, last minute entries cash only.
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