Rock and Jock Rockin’ Redfish Challenge Registration Form – May 30th 2015 Bring your completed form with either cash, credit card or money order to Beasley Media Studios located at 20125 S. Tamiami Trail Estero, FL 33928 During normal business hours Monday thru Friday 9am to 5pm No personal checks will be accepted after May 7th , 2015 Any Questions Call Jason Jones @ 239-495-2100 $450 per team, up to four people including Captain (After May 7th 2015)($50 discount if before May 7th, 2015) Please make checks/money orders out to Beasley Media Group, Inc. Total Anglers (including captain): _________ Total Payment included: _________ Every registered angler agrees to abide by the Tournament Rules and consents to the use of any photographs. By signing the registration form, the angler accepts responsibility for reading and understanding the Official Rules of the Tournament. PLEASE REVIEW RULES & REGULATIONS CAREFULLY *PLEASE BE SURE TO COMPLETE ALL FIELDS BELOW, INCOMPLETE FORMS WILL NOT BE ACCEPTED. PROOF OF FISHING LICENSE IS REQUIRED FOR ALL ANGLERS 16 AND OVER ALL PERSONS UNDER 21 MUST BE ACCOMPANIED BY SOMEONE OVER THE AGE OF 21 TOURNAMENT IS OPEN TO FLORIDA RESIDENTS ONLY Team Name: _______________________________ Captain:_______________________________ Phone #: ________________________ Captain Email: ____________________________________________________ The Captain has reviewed the rules of the Rock & Jock Fishing Tournament and agrees to adhere to the rules. Captain Signature: _____________________________ OFFICE USE ONLY: Team Number: ____________ Paid in Full: __________ Balance Due: $ __________ Date: ___________ Paid Amount: $ ___________ Ck #___________ CC______ Cash ______ Captain and Angler #1 Name: _________________________________ Email: _______________________________________ Signature: _______________________________ Phone: _______________________________________ Address: ________________________________ City: _______________ State: _______ Zip: _________ Shirt Size: S____ M____ L____ XL____XXL____ Fishing License #: _______________________________________ Birthdate: ____________________ Angler #2 Name: _________________________________ Email: _______________________________________ Signature: _______________________________ Phone: _______________________________________ Address: ________________________________ City: _______________ State: _______ Zip: _________ Shirt Size: S____ M____ L____ XL____XXL____ Fishing License #: _______________________________________ Birthdate: ____________________ Angler #3 Name: _________________________________ Email: _______________________________________ Signature: _______________________________ Phone: _______________________________________ Address: ________________________________ City: _______________ State: _______ Zip: _________ Shirt Size: S____ M____ L____ XL____XXL____ Fishing License #: _______________________________________ Birthdate: ____________________ Angler #4 Name: _________________________________ Email: _______________________________________ Signature: _______________________________ Phone: _______________________________________ Address: ________________________________ City: _______________ State: _______ Zip: _________ Shirt Size: S____ M____ L____ XL____XXL____ Fishing License #: _______________________________________ Birthdate: ____________________ www.96krock.com - www.993espn.com