2011 Bass Tournament
Horsehead/John Brown Lakes

Registration Form
Cost per 2 person team $50.00
Participant Information:
Name: __________________________ Phone: ____________________
Address: ___________________________________________________

Name: __________________________ Phone: ____________________
Address: ___________________________________________________

Waiver of Liability:
Horsehead Lake Association and its members as well as Bruce Rutter and any associate affiliated with the Bass Tournament are not responsible for any damage to your watercraft, fishing equipment or any personal injury, while participating in this Bass tournament.  Tournament participation is at your own risk.

Signature: ______________________________________ Date: _________________________

Signature: ______________________________________ Date: _________________________
Make checks payable to Bruce Rutter.  Mail to 810 E. Baldwin St, St. Johns, MI  48879.
Call 989-640-1203 if you have any questions.