2010 Camp Mak-A-Dream Walleye Benefit Entry Form

Tourney hours: 7 a.m. to 3 p.m., Saturday, Aug. 14, 2010

Barbecue from 5 to 7 p.m., rules meeting at 7 p.m., Friday, Aug. 13, 2010

at the Silos, Canyon Ferry Reservoir

Sponsored by Walleyes Forever and Montana PikeMasters

(Membership not required to fish this event)

Team Captain:

Name____________________________________ E-mail________________________________

Address___________________________________________ SS#_________________________

City________________________________________ State_______________ Zip_____________

Home Phone (_____)_____________ Work or Cell Phone (____)_______________

Additional team members:

Name___________________________________________________ Age if under 16:_________

Entry fee: $60 per boat (includes $50 tourney entry fee and $10 conservation fund fee)

Make checks payable to: Camp Mak-A-Dream Walleye Benefit

Mail entry to: Camp Mak-A-Dream Walleye Benefit, 1303 W. 4^th St., Laurel, Mont. 59044

For information: Call Tournament Director Peggy Lawver at (406) 855-8432

Release of Liability. By signing the tournament entry form, I and all participants in my boat agree to the following:

I and everyone in my boat understand that in consideration of being permitted to participate in the Camp Mak-A-Dream Walleye Benefit, for myself, heirs, successors, executors, administrators and assigns, hereby release and forever discharge any of the sponsors, committee members, participants, or any other entity from any and every claim, demand action or right of action, of any kind and nature, either in law or in equity, arising from or by reasons of any bodily injury or personal injuries, known and unknown, death or property damage resulting or to result from any accident which may occur as a part of my participation in this tournament, whether by negligence or otherwise. I and everyone in my boat also release all officials, staff, participating sponsors, and participants from any claim whatsoever on account of first aid, treatment or services rendered me during my participation in this tournament. Furthermore, if it is determined that any rescue or other difficulty I incur is due to my own negligence, I and everyone in my boat will be responsible for any and all fees associated with these efforts.

Team captain’s SIGNATURE:

X__________________________________________ Date__________

100 percent of tourney entry fees will be donated to Camp Mak-A-Dream