(Please print clearly - ENTER AS A TEAM!)

Gopher Bassmasters, 1047 Como Place - St. Paul, MN 55103

1st Partner:

Name: _______________________________________________

Address: _____________________________________________

City: ______________________  State: _________  Zip: _____________

Phone  (          ) _____________________   Age:  _____

E-Mail:  _____________________________________________

By signing this entry forum I have sufficient health, accident and liability insurance to cover any bodily injury or property damage incurred by myself or others as a result of my participation in this event.

Signature:   ___________________________________________

2nd Partner:

Name: ________________________________________________________

Address: ______________________________________________________

City: ______________________  State: _________  Zip: _____________

Phone  (          ) _____________________   Age:  _____

E-Mail:  _____________________________________________

By signing this entry forum I have sufficient health, accident and liability insurance to cover any bodily injury or property damage incurred by myself or others as a result of my participation in this event.

Signature:   ___________________________________________

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