Starting position determined by date received
Date: __________________________________________________ ___________
Name (Print) __________________________________________________ _____________
Name (Sign) __________________________________________________ _____________
Address: __________________________________________________ _____________
City: _______________________________________ State: ________
Zip: _______________
Mail to: City of Warsaw, C/O Bass Tournament
P.O. Box 785
Warsaw, Kentucky 41095
Please Include Entry Fee: $100
Make Checks Payable to Gallatin County Bass Club
NOT RESPONSIBLE FOR ACCIDENTS