2024 Fall Madness Payment Form

2024 Fall Madness Online Entry
October 11 - November 17, 2024
Online Entry Deadline is 11:59pm Oct. 9th, 2024

The Submit Button at the bottom of this form will direct you to a payment screen where you can pay with credit/debit card or Paypal. The $41.50 payment will cover your $40 entry fee and a $1.50 convenience fee.

First name

Last name

Street Address

City

State

Zip Code

Phone

BY SUBMITTING THIS APPLICATION, YOU AGREE TO THE FOLLOWING Participant Agreement, Release, and Acknowledgement of Risk: Upon signing this application, I hereby waive and release all other participants, hosts, sponsors, and tournament officials from any and all liability claims, demands, actions or rights of actions, which are related to, arise out of, or in any way connected with my participation in this tournament, for any and all claims of death, personal injury, accidents, theft and damage to myself, to others, and all equipment involved in this tournament. I voluntarily assume full and all responsibility for my health and safe being arising from my participation in this tournament. I assume full responsibility for all equipment on and off the water during this tournament. I have sufficient health, accident and liability insurance to cover any bodily injury or property damage incurred by myself or others as a result of my participation in this tournament. If I have no such insurance, I represent that I am capable of paying for any and all such expenses or liability. I have read and understand the rules of this tournament and I will obey all rules and understand that any violation may result in immediate disqualification without refund of my entry fee. I also understand that tournament officials may reject my application for any reason, and in that event will refund my entry fee. Gulf Coast Lady Anglers and their assigns, have my permission to use my name, photographs, and film footage of me if it chooses to do so. By submitting this form I agree that I have read the entire document, understand it completely, understand it affects my legal rights and agree to be bound by its terms. References to “I,” “Me,” “Myself,” and other first person references shall include any child or ward to whom I sign. The Submit button below will take you to Paypal. The $41.50 payment will cover your $40 entry fee and a $1.50 paypal fee.

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