2007 David "Crash" Mullins Multiple
Myeloma Foundation Muskie Outing
 

ENTRY FORM

Please submit entry by October 6th. Entries will be accepted the morning of the event but start time will not be delayed if participants

are still in line to pay entries.

 

Name (Print)

SSN#

 

Contestant #1

 

 

 

Contestant #2

 

 

 

Contact Address

Street:

City:

State:

Zip:

Telephone #

(           )

 

Entry Fee:  $100 

Send to:  Chipper Bushong
2545 Cranston Rd, Morehead KY 40351

Checks payable to:  Muskies Inc., Chapter 52

For more information contact: Scott Smalley at 
606-584-0046 or sasmalley@yahoo.com

RELEASE OF LIABILITY – READ CAREFULLY BEFORE SIGNING

  • Both team members must sign!

  • In consideration of being permitted to participate among and on the boats under the auspices of Muskies, Inc. International and The Daniel Boone Chapter, I acknowledge, appreciate, and agree that:

    1.        I am aware of the inherent risk associated with fishing and boating, including but not limited to the risks of collisions with other boats and stationary objects in and around the lake, including rocks, reefs or piers or other vehicles and trailers at landing areas.  I am familiar with other risks up to and including death by drowning associated with rough water, changing weather patterns, heavy winds and lightning storms.  I expressly assume all risks associated with this tournament and I hereby release Muskies, Inc. International and The Daniel Boone Chapter of Muskies, Inc. the host sponsors, and tournament officials from all claims of negligence resulting from injury and/or property damages incurred in connection with the tournament.

    2.        I knowingly and freely assume all such risks, both known and unknown even if arising from the negligence of those persons released from liability below, and assume full responsibility for my participation and

    3.        I will comply with all rules and regulations.  If I have any questions, or observe any unusual or unnecessary hazard during my participation, I will immediately bring such to the attention of the nearest official; and

    4.        I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold harmless the Muskies, Inc. International and the Daniel Boone Chapter, the owners and lessors of premises used to conduct the tournament, their officers, officials, (“Releasees”), with respect to any and all injury, disability, death or loss or damage to person or property, whether caused by the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

 Boater’s Signature_________________________________________________Date:____________________

 

Partner’s Signature_________________________________________________Date:____________________

FOR PARTICIPANTS OF MINORITY AGE (Under 18 at time of registration)

This is to certify that I, as parent/guardian of the participant, do consent and agree to his/her indemnification, release and hold harmless as provided above of all Releasees, and I, for myself and on behalf of my heirs, assigns and next of kin, hereby release, indemnify and hold harmless the Releasees from any and all claims incident to my child’s involvement in these programs even if arising out of the negligence of the Releasees, to the fullest extent permitted by law

Parent/Guardian Signature:___________________________________________Date:_____________________