Send Entry Form and Entry Fees to:                                                                        Entry Fee: $50.00 per boat
Don Farmer                                                                                                           Side pot BB $10.00 ______
16768 S 1418 Rd.                                                                              2012 Annual Membership fee $10.00 per person
Nevada Mo 64772                                                                                                    Lake____________________
Make checks payable to
(NEVADA BASSCASTERS)                                                                                                                             
                                                                                                                              Date____________________


Boater
                                                                                        Buddy

Name______________________________________              Name  _________________________________

Address____________________________________              Address ________________________________

City _______________________________________              City ___________________________________

State, Zip __________________________________               State, Zip ______________________________

Phone _____________________________________               Phone _________________________________


Email Address________________________________              Email Address____________________________

I hereby apply to enter the Basscasters Open Buddy Tournament. I have read and understand the rules and waive and release all other contestants, the Host, Sponsors and tournament officals from all claims of injuries and/or damages incurred in connection with the tournament. (NO REFUNDS).


Boaters Signature ______________________________  Buddy's Signature ______________________________