Official Internet Entry Form

Exchange Club Blue Water Open

Please print and complete before mailing to address listed in form

May 24, 2008 - Weather Date: Sunday May 25, 2008

Entrant's Name________________________  Phone_____________

Address____________________________     email address:________________

City_____________________  State________  Zip__________

Boat Name________________________________

Manufacturer______________________________  Length____________

Hull Color_____________________ Registration #________________

Captain's Name_____________________________________________

Home Phone__________________  Cell Phone_______________

Entry Fee per Boat... $200   

(Registration prior to May 15, 2008 entry fee is $150 per boat)

Entry Fee includes one(1) Tournament Tee shirt and registration for door prize. 

Make checks payable to:   Exchange Club of Indian River Foundation                           P.O. Box 93, Vero Beach, FL 32961

ENTRY FEE MUST ACCOMPANY OFFICIAL INTERNET ENTRY FORM                   Total Enclosed: $_________

I can't fish in the Tournament, but here's my donation to help the kids.                              Check Enclosed: $_________

In consideration of acceptance of my/our entry, I/we nor my/our heirs, executors and administrators, release and forever discharge the Exchange Club of Indian River Florida, its members or Directors, The National Exchange Club, and the Fort Pierce City Marina where the event is held, and all sponsors, producers, their agents, representatives, successors and assigns of all liabilities, claims, actions, damages, costs or expenses which I/we may have against them arising out of or in any way connected with my/our participation in this event, including travel to or from this event, and including injuries which may be sustained by me/us before, during or after the event. I/We understand that this waiver includes any claims based on negligence, action or inaction of any of the above parties.

Angler #1 Name (printed)_______________________________________

Signature____________________________ Date _____________Phone __________

Angler #2 Name (printed)_______________________________________

Signature____________________________ Date _____________Phone __________

Angler #3 Name (printed)_______________________________________

Signature____________________________ Date _____________Phone __________

Angler #4 Name (printed)_______________________________________

Signature____________________________ Date _____________Phone __________