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Nakina Fish & Game Club
Box 412 – Nakina, ON – P0T 2H0
Phone: (807) 329-5747
Fax: (807) 329-5747
Annual Live Release Bass Derby
Cordingley Lake, Nakina, ON
August 10th, 11th, & 12th 2012.
Entry Fee: $160.00
Registration, Waiver of Claim, Release and Indemnification Form.
Admiral: ____________________ Captain: _____________________
Address: ____________________ Address: _____________________
____________________ _____________________
City: _______________________ City: _________________________
Phone: _____________________ Phone: _______________________
Email: _____________________ Email: ______________________
We hereby waive and release all contestants, sponsors and tournament officials from claims, injury or damage incurred in connection with this tournament. Photographs taken during this tournament can be used without compensation or notice for compensation or promotion.
Signature of Signature of
Admiral: ____________________ Captain: _____________________
Date: _______________________ Date: ________________________