KY Lake KY Damn Village – 6-24-23

KBN ADULT QUALIFIER 4

Registration

KBN ADULT QUALIFIER 4\ 6/24/23 KY Lake KY Damn Village

Payment Type

Credit/PayPal

Check

Date

Boater Or Non- Boater

Angler $120

Co- Angler $80

Guarantee

First And Last Name

Address

City

State

Zip

Phone

B.A.S.S #

Exper. Date

Club Name

All Regional events will have a payback Make all checks payable to Kentucky B.A.S.S. Nation. Having acquainted myself with the rules, I have completed this application. In signing this application, I hereby agree to be bound by and comply with all tournament rules and regulations. I expressly assume all risks associated with the tournament and I hereby release B.A.S.S., LLC., its parent, affiliated and subsidiary companies, the host, sponsors and tournament officials from all claims of death, injury and/or property damage incurred by me in connection with my participation in this tournament. If I am using my own boat in the tournament, I certify that I now have or will obtain prior to the tournament, property damage insurance having a limit of at least $300,000.00. The insurance must be issued by a reputable insurer rated A or better by A.M. Best and Co. and must cover B.A.S.S., LLC., its parent and affiliated companies, its licensees, and affiliates, their advertising agencies, and all of their respective officers, directors, agents, employees, and stockholders. At B.A.S.S.’ request, I will provide it with satisfactory evidence of that insurance. I hereby waive my rights of privacy or publicity with the regard to the programs of the tournament in which I appear and consent to B.A.S.S., LLC’s (and its parent, affiliated and subsidiary companies, and those acting under their permission or upon their authority), copyrighting, distributing, televising, publishing and using in any way the audio and visual portions of any television videotape, film and photographs or pictures of me or of interviews, scenes or other sequences in which I may be included, and any reproduction thereof, anywhere at any time through any medium or media for advertising, promotion, trade, television programming or other lawful purpose whatsoever; and I shall not be entitled to receive any royalties or other compensation in connection with such use. I further understand and agree that the Tournament Director reserves the right to reject my application for any reason. I am currently a member in good standing with B.A.S.S.. I agree if I qualify for the Bassmaster Classic or B.A.S.S. Nation Championship, to use any and all (official) products and equipment so specified and provided by B.A.S.S..

Signature - (By checking this box you affirm you are signing this document)

MAIL CHECK TO:
1103 Tammy Drive Paris, KY 40361

“postmark checks 14 days prior to event”