OFFICIAL REGISTRATION AND WEIGH-IN FORM

POTOMAC TEAMS BASS TOURNAMENTS

TOURNAMENT DATE_____________ TOURNAMENT BOAT REALEASE NO.____________

DO YOU WISH TO ENTER LUNKER POT? ($10/BOAT) YES____ NO____

1. BOAT OWNER E-mail________________________

Name________________________ Phone No.(___)______________

Address___________________________ (Addresses & phone no's not

needed if you are already

______________________ registered as team this yr.)

(City State zip)

2. PARTNER

E-mail____________________

Name_______________________ Phone No. (___)______________

Address_______________________________

____________________

(City State Zip)

We, the undersigned, hereby assume all risk for any injuries or losses that we may sustain or cause to others in the pursuit of tournament activities and do hereby remise, release and forever discharge Potomac Team of Virginia and/or its members and officers from any actions, suits, claims or judgments that may result from any injuries or losses sustained on the Potomac River and connected tidal tributaries while engaged in activities of Potomac Teams Tournaments. We understand and voluntarily agree to abide by the rules for Potomac Teams events as they are printed and/or announced. We voluntarily agree to take polygraph tests if requested to do so by tournament officials or forfeit any prospective winnings. We further agree to the contents of this paragraph with respect to any other Potomac Teams events, which we participate in during the current calendar year, as indicated by our individual signatures.

Signature____________________________________Date______________

Signature____________________________________Date______________

1

IF YOU WISH TO PRE-REGISTER, SEND CHECK OR MONEY ORDER AT LEAST ONE WEEK IN ADVANCE TO Bob Pettey 13427 Greenacre Drive Woodbridge Virginia 22191

703-491-3321 (NOTE: TOURNAMENT RULES PRINTED ON REVERSE OF THIS FORM.)

________________________________________________________________

Entry Fee Paid: Yes_____

Lunker Fee Paid: Yes_____

No. Fish: Weight: Big Fish:__________

Live_______ Gross___________ Gross________

Dead_______ Dead pen.________

Total______ Late pen.________

Short pen._______

NET WT.________