Southern lake michigan smallmouth slam

st Annual Southern Lake Michigan Smallmouth Slam!

Proceeds are for the benefit of the Orak Shrine and are not tax deductable.
June 25 Portage Marina (If bad weather we will will fish on Sunday)
$200 Entry Fee
Tournament Time: Safe Light Till 4PM
Trailered weigh In at PASTRICK MARINA
Pre-tournament Meeting held at Bass Pro Shops - Friday June 24 at 6PM
Boat positions will be drawn at pretournament meeting
Contact Dave Heath 219-405-4330 email: [email][email protected][/email]

In signing this entry form, I hereby waive and release all other contestants, the sponsors and tournament officials from all claims of injury and / or damage incurred in connections with this tournament. I further understand and agree that the tournament director reserves the right to refund this entry fee if it shall choose for any reason not to accept this entry form. I also agree to accept the fact, that all decisions made by the tournament officials will be final. I swear that all facts submitted are true and accurate to the best of my knowledge.

NAME ___________________________________ NAME ____________________________________
ADDRESS _______________________________ ADDRESS_________________________________
CITY ____________ STATE_________________ CITY_______________STATE_________________
ZIP___________ PHONE___________________ ZIP_____________PHONE___________________
EMERGENCY # ( ) ______________________ EMERGENCY#( )_________________________
WORK # ____________ CELL #______________ WORK#______________CELL_________________
CONTACT PERSON_______________________ CONTACT PERSON_________________________
SIGNATURE_____________________________ SIGNATURE _______________________________
SSN # __________________________________ SSN#_____________________________________
BOAT MAKE_______________________COLOR_______________IN#__________________________

CHECKS OR MONEY ORDERS MADE PAYABLE T0:
Dave Heath