VIP

2017 JOLLY MON VIP
ENTRY FORM

BOAT NAME:    _____________________________   

CAPTAIN'S NAME :_________________________________________

ADDRESS:    ______________________________________________________________________________

CITY:    ___________________________________________    STATE:    ___________    ZIP:    ___________

CELL PHONE:    __________________________   EMAIL ADDRESS:    _________________________________


S.S.#    ______________________________  (required)

WAIVER CONTRACT:
I understand that I as registrant/captain/boat owner, am responsible for my boat and occupants at all times.  I have read and fully understand and agree to abide by all rules of the 2017 Jolly Mon VIP.  I hereby release the Jolly Mon
VIP, its sponsors, their principles, theirs subsidiaries, and their affiliates from any and all liability.  I further understand that the decision to fish and participate is the responsibility of the registrant/captain/boat owner.

 

SIGNATURE:    _________________________________________________    DATE:    ______________

ENTRY:    $210 - required

OPTIONAL TWTs:

 ____ $105 King Mackerel    ____ $105 Amberjack    ____ $105 Barracuda

TOTAL DUE:  $ ___________

FILL OUT THE ENTRY FORM, PRINT IT, INCLUDE PAYMENT AND MAIL 
Make checks payable to:
Jolly Mon VIP -  P.O. Box 895 - Shallotte, NC  28459

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