! ! ! The Mid-Atlantic 5wt Fly Casting Championship June 20, 2015 Allenberry Resort, Boiling Springs, PA Name:_________________________________________________ Address:_______________________________________________ City, State, Zip:_________________________________________ Email:_________________________________________________ Phone:_________________________________________________ Sex: Male:____ Female:____ Age Group: _____ Youth (< age 19 as of 6/20/15) _____ Adult (age 19 > as of 6/20/15) Category: ____ Angler (basic and intermediate casters) ____ Expert /Open (casting instructor, guide, competitive caster) Registration fee: Open /Adult: $25.00 Pre-register, $30.00 day of event. Youth and Angler Women: No fee I certify that I have read the event rules and requirements and understand that CVTU may disqualify me and retain my entry fee if I fail to meet all entry and equipment requirements. Sign and date: ______________________________________________ Mail completed form postmarked NOT LATER THAN June 12, 2015, to: CVTU Attn: Mid-A Fly Casting Championship PO Box 520 Carlisle, PA 17013