Official Entry Form

Deadline Friday May 5th 2008

Application for Participation In

The Mississippi Walleye Club,

“Kid’s Day Fishing Tournament / Sportsman’s Expo”

Saturday, August 16th, 2008

School: _______________________________

Teacher Name: _________________________

Name (Print):___________________________

Age: ___________________

Grade: __________________

Phone: ____________________________

Gender = Girl____________Boy_________

Address: ____________________________

City: ______________________________ State: ______ Zip: ___________

Parent/Guardian (Print):

Student signature: _________________________

Parent/Guardian signature: _________________

Fishing is a life long sport. Something you can do alone, with your best friend, your family or anyone. Many adults who grew up with a fishing pole in their hands feel it is one of the best sports they ever started because of the rewards all through their life.

In your essay of one hundred (100) words or less, we would like to know what you think you will gain, learn, and develop from this fishing experience

Your essay to the following statement will be judged against all other students to determine who will be invited to participate in The Mississippi Walleye Club, Inc., Kid’s Day Fishing Tournament /Sportsman Expo which is offered to grades 4, 5, & 6. Use additional sheets if you need more space.

“Why I Want To Go Fishing”

Waiver

We, the parents or legal guardian of the undersigned applicant do hereby consent that said applicant may participate in The Mississippi Walleye Club, Inc., Kid’s Day Fishing Tournament /Sportsman Expo, Saturday, August, 16th 2008 under the rules and regulations of this activity. We do further release and hold harmless The Mississippi Walleye Club, Inc., and any persons, property owners, boat owners, boat operator or sponsors, assisting or participating in this aforementioned Tournament/Expo, from any and all liability or damages for injury to the undersigned applicant and further agree to reimburse any of the aforementioned parties for the cost of damages paid as a result of any action by the undersigned applicant or any other person on said applicant’s behalf.

Dated and signed this ____________day of __________________2008.

Applicant (full name) (print): _____________________________________

Parent (signature): ______________________________________________

Legal Guardian (signature): ______________________________________

Applications may be mailed to:

Mississippi Walleye Club

P.O. Box 748

Dubuque, Iowa 52001