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NAME: _______________________________________ STREET: _____________________________________ CITY: _________________ ZIP:

4 th Annual Tiffany Thomas Memorial Fishing Tournament. Registration Form. NAME: _______________________________________ STREET: _____________________________________ CITY: _________________ ZIP: ___________________ SEX: ________ AGE: _______ T-SHIRT SIZE: ______

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NAME: _______________________________________ STREET: _____________________________________ CITY: _________________ ZIP:

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  1. 4th Annual Tiffany Thomas Memorial Fishing Tournament Registration Form NAME: _______________________________________ STREET: _____________________________________ CITY: _________________ ZIP: ___________________ SEX: ________ AGE: _______ T-SHIRT SIZE: ______ PHONE: ______________________________________ SIGNATURE: _________________________________ Email _________________________________________ NAME: _______________________________________ STREET: _____________________________________ CITY: _________________ ZIP: ___________________ SEX: ________ AGE: _______ T-SHIRT SIZE: ______ PHONE: ______________________________________ SIGNATURE: _________________________________ Email ________________________________________ In signing this application, I hereby waive and release all other contestants, the hosts, sponsors and tournament officials from all claims of injury and/or damage incurred in connection with this tournament. I have become familiar with and agree to abide by the tournament rules as they are posted on the Tiffany Thomas Memorial Foundation website. I swear that the above facts are true to the best of my knowledge, and enclose herewith my application fee. ***Please provide email information if available so that we may send you newsletters with updates regarding the Foundation and tournament. Entry Fee: $100.00 per boat Please make checks payable to: Tiffany Thomas Memorial Foundation 51005 Hwy. 445 Loranger, LA 70446 Entry Deadline: April 20, 2013, 6:30 a.m.

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