"PURE JACKPOT"

ENTRY APPLICATION
(Please print clearly)

BOAT NAME: ________________________________________ Trailer: Yes / No (circle one)

Captain's Name: ____________________________________ Date:____________________

Address: __________________________________City _________________ Zip _________

Phone: (Res.) __________________(Bus.) __________________ Boat's HA No.: _________

Entry Fee: $200.00 Cash/Check # : _________

Make check payable to: KEEHI BOAT CLUB TOURNAMENTS

Mail or bring to: Keehi Boat Club, 4 Sand Island Access Road, Box 44, Honolulu, Hawaii  96819-2221

If you mail your application, Please call KBC 841-7271 three days after mailing.
This is to verify that your application did not get lost in the mail.
Last date to enter is at Captain's Briefing

All persons on board a tournament boat must sign the standard waiver form (See back of this application). If the person is a minor (under the age of 18), permission and signature of a parent or legal custodian is required. A captain must be designated on the waiver form.

Completed waiver forms should be turned in with the entry application. Changes and Waiver form for additional crewmembers may be made/turned-in prior to or at the captains briefing. Prior to start fishing all waiver forms must be approved or the boat will be disqualified and ineligible for any tournament prizes.

Thank you for entering

KBC Pure Jackpot