Application Form
Canadian Walleye Championship
OCTOBER 25th & 26th 2008 Presented by Broadlands Mall
Mr. Kim Wilson
P.O. Box 797
Pine Falls, Manitoba.
R0E 1M0 		 
CAPTAIN'S NAME:____________________________________________________________________________
ADDRESS:____________________________________________________________________________________
PHONE:__________________________________________E-MAIL_____________________________________
PROV./STATE:________________________________________________________________________________
POSTAL/ZIP CODE:____________________________________________________________________________
PARTNER'S NAME:____________________________________________________________________________
ADDRESS:____________________________________________________________________________________
PHONE:__________________________________________E-MAIL_____________________________________
PROV./STATE:________________________________________________________________________________
POSTAL/ZIP CODE:____________________________________________________________________________
BOAT (MAKE, MODEL, SIZE):__________________________________________________________________
MOTOR (MAKE AND POWER):_________________________________________________________________
SPONSOR(S), (IF ANY):_________________________________________________________________________
AMOUNT 
ENCLOSED:
$_________		 CHECK_____  CASH_____  VISA_____
Cardholder name _____________________________
(as it appears on card)
Card number ________________________________
Expiration Date_______________________________
(3% PROCESSING FEE WILL BE CHARGED)
ENTRY AMOUNT $700.00 CDN PER TEAM.
Mail all entries to:
Tournament Director
Mr. Kim Wilson
P.O. Box 797
Pine Falls, Manitoba.
R0E 1M0
Canada
Phone:
Store:
(204) 367-4665
Home: 
(204) 367-8442
Fax:
(204) 367-4334
E-Mail
broadlandsmall@hotmail.com
LIABILITY RELEASE :
1. In signing the agreement I hereby release Broadlands Mall, its officers, agents, employees and sponsors from any and all damages, claims, demands, cost or expenses relating to injury of any persons or any property which I may sustain or which I may cause by reason of participating in or in connection with this tournament.
2. I further consent and agree to grant CWC the full use of any name, still pictures video and voice likeness and background information in connection with the CWC productions, articles and press releases.  I further understand that I will not be entitled to receive moneys, royalties, or other compensation.
3. Prize payout based on 80 teams entering; total prize may vary from that which has been advertised.
4. I signify by signature that I have read and understand the agreements numbered 1 & 2 above.
BOAT CAPTAIN SIGNATURE____________________________________

PARTNER OF THE TEAM___________________________________

Are you interested in the Pro Angler & Youth Mini Tournament?   YES____       NO____

TEAM MAY SECURE A SPOT WITH $100.00 CDN DOWN AND THE REMAINING TO BE PAID 6 WEEKS PRIOR TO TOURNAMENT.