FLORIDA DISABLED ANGLERS, INC.
Annual Registration & Release Form

 

BOATER       First Name ________________ Initial _____ Last Name ___________________

 

Address _____________________________ City_______________ State____ Zip _______

 

Phone # (_____)____________________ Cell # (_____)____________

 

Pager # (_____)____________  E-Mail Address ____________________________________

 

Brand of Boat_______________ Color_____________ Registration #______________

 

Brand of Engine__________ Engine H.P. ______ Tow Vehicle _____________ Color_____

 

NON-BOATER First Name _______________ Initial _____ Last Name ___________________

 

Address _____________________________ City_______________ State____ Zip _______

 

Phone # (_____)____________________ Cell # (_____)____________

 

Pager # (_____)____________  E-Mail Address ____________________________________

 

Type of Disability _____________________________________________________________

 

Special Remarks or Concerns: __________________________________________________
 

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IN THE EVENT OF AN EMERGENCY PLEASE NOTIFY

 

Name__________________________________________________________

 

Phone # (_____) ________ - _________ *************************************************************************************************************

Having acquainted myself with the Rules and Regulations of Florida Disabled Anglers, Inc., I have completed this Registration & Release form and submitted it for my entry into the Florida Disabled Anglersí Tournament Trail. In signing this form, I hereby agree to be bound by and comply with all tournament rules and regulations and the fishing laws and regulations of the state of Florida. I expressly assume all risks associated with this Tournament Trail and hereby release Florida Disabled Anglers, Inc., its Officers, Board of Directors, Sponsors, and Tournament Officials from any and all liability, claims of injury and / or damages incurred in connection with the Tournament Trail. This signed release form applies for the entire year dated below and covers all activities associated with Florida Disabled Anglers, Inc.

Signature__________________________________________________ Date______________


If the applicant is a minor, (under age 18), this form must be signed by a parent or legal guardian below.

Signature__________________________________________________ Date______________

Please complete this form, signed and dated, and bring it with you to your first tournament or
mail to Florida Disabled Anglers, 2711 S. Design Court, Sanford FL 32773