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2010 17th Annual Fishing Break Guest Signup

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Guest Contact Information Guest signup includes dinner for both Friday and Saturday night, a T-shirt and Cap.  Entertainment by two bands - The Jim Halfpenny Band and The Carport Casanovas.  Registration Cost is $55.00 per guest.  Early Registration ended June 1, 2010.

First Name             Last Name    

Organization    

Credit Card Billing Name      

Street Address    

Street Address (Line 2)    

City             State             Zip Code    

Cellular Phone             Home Phone    

Email Address    

Guest Information You can sign up 1  - 4 guests.  If you are signing up more than 4 guests, please submit additional entries on separate form.

   Guests               1.        2.        3.        4.

T-Shirt Size            1.             2.             3.             4.

Comments

 


I, the Releasor, have read and I agree to the following terms:

(“Releasor”), for himself/herself and his/her executor, children and assigns, and the other members of his/her team, releases Todd Purcell, Purcell Enterprise’s, Inc., Austin Firefighters Relief and Outreach Fund., the City of Port Aransas, TX, and its shareholders, directors, officers, employees, agents, sponsors, successors and assigns (the “Proprietor”) from any and all liability for property damage, personal injury, or emotional distress arising out of Releasor’s use of property, equipment, or engagement of any lawful activity associated with that certain fishing tournament and related lawful social activities thereto (the “Tournament”) taking place on or about June 25th, 2010 through June 26th, 2010 and agrees to hold Proprietor and its shareholders, directors, officers, employees, agents, successors, sponsors and assigns free, clear, and harmless from any and all claims and demands for personal injury or property damage arising out of Releasor’s participation in said Tournament or any lawful activity associated with Proprietor.  Furthermore, participation in said Tournament by Releasor and his/her teammates is evidence that Releasor and his/her teammates agree to the above terms.

    

      

 

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