CASTAWAY ENTRY FORM

TOURNAMENT DATES__________________________________

BOATER______________________________________________

ADDRESS_____________________________________________

CITY/STATE/ZIP_______________________________________

PHONE( )____________________________

SS#_________________________________________

NON-BOATER__________________________________________

ADDRESS_____________________________________________

CITY/STATE/ZIP________________________________________

PHONE ( ) ____________________________

SS#__________________________________________

By signing this application I agree to indemnify, defend, and hold harmless Castaway Sporting Goods, All contestants and it's shareholders, Directors, Officers, Partners and Employees from and against claims, demands, damages, costs, expenses, fees, fines, and other liability arising out of the death or injury of any person occurring at any time as well as any property damage incurred in the connection with this tournament. If transferred this agreement will apply to a new participant. I also agree that refusal to submit to or failure of a polygraph examination will result in disqualification and forfeiture of any cash and prizes. The tournament committee reserves the right to refuse entry to this tournament to anyone.

Signature _________________________________Date_______

A $15.00 late fee will be applied to all entries received after 6:00 pm Saturday night week prior to the scheduled tournament event. Withdrawal from an upcoming tournament can be accomplished anytime before 6:00 p.m Saturday week prior to the scheduled tournament event. by contacting Wayne or Kim Andrews at Castaway Sporting Goods at 804-706-9100.There will be a $25.00 fee for all withdraws and transfers. No withdrawals or transfers may be accomplished after 6:00 p.m. Saturday week prior to the scheduled tournament. Entry Fee for James River Tournaments $90.00 includes Big Fish. Entry Fee for Kerr Lake $100.00 includes Big Fish.

Mail To:

Castaway Sporting Goods

11600 Jefferson Davis Hwy

Chester, VA 23831

804-706-9100