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William Small Benefit Event

Falls Lake          November 5th, 2023 

Ledge Rock Boat Ramp 

Time: Safe light-3pm

ENTRY FEE: $100 Per Team     75% PAYBACK

BIG FISH ENTRY (Optional): $10 Per Team     100% Payback

TWT (Optional): $50 Per Team     100% Payback

PARTNER #1: (Print)

NAME_______________________________________________PHONE #_________________
ADDRESS_________________________________________________________________________________
CITY, STATE, ZIP__________________________________________________________________________
EMAIL ADDRESS:_________________________________________________________________________

PARTNER #2: (Print)

NAME_______________________________________________PHONE #________________
ADDRESS_________________________________________________________________________________
CITY, STATE, ZIP_________________________________________________________________________
EMAIL ADDRESS:_________________________________________________________________________

Having read the rules concerning this tournament & signed this application for entry, I agree to waive & release the sponsors, other contestants, host marinas & their agents, polygraphers & tournament staff of all claims of personal injury, property damage or loss thereof, loss of life or any other liability incurred by me or my partner while participating in this event. I agree that the above statements are true & agree to take a polygraph test if requested & will accept the decision of the polygraph operator & tournament director thereafter. I also have boat liability insurance, a current Fishing License, the current Boat Owners Registration & current ID.

Partner #1 Sign:_______________________________________________________Date:________
Partner #2 Sign:_______________________________________________________Date:________

Mail Entries To: Doug Phillips. Make Check or Money Order out to 'Doug Phillips'
Starting QUALIFIERS positions determined by time entry is received. Flights determined by number of entries. 
Entries will be taken morning of the tournament up until blast-off. Others may enter up to 1 hour after blast-off.
PLEASE! CASH ONLY AT THE RAMP!   Contact Phone Number: Doug 912-980-5936 or Gretchen 337-348-9003

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