2010 AINAD BASS TOURNAMENT ENTRY FORM

In signing this application, I hereby waive and release all other contestants, the host, sponsors and Tournament Officials from ALL claims or injury and/or damage incurred in connection with this Tournament. Your signature constitutes submission to a Polgraph Examination in respect to your catch. Upon receipt of this application and payment you will receive confirmation and your entry number within two weeks.

PLEASE PRINT:

Boat Owner __________________________ ARE YOU A SHRINER? YES NO

Address ______________________________

City _________________________________State______________ Zip __________

Signature ____________________________ Telephone No. ___________________

Partner _____________________________ ARE YOU A SHRINER? YES N0

Address_______________________________

City _________________________________ State _____________ Zip __________

Signature ____________________________ Telephone No. ___________________

Are you being sponsored? YES N0 By Whom ___________________________

Enclose a check or money order made out to: Ainad Shriners Bass Tournament

Mail entry form and payment to: Ainad Shriners, 609 St. Louis Ave., East St. Louis, IL 62201-2927

Proceeds from this activity are for the benefit of Ainad Shriners operations. Payments are not deductible as charitable contributions.