2018 OFFICIAL NMBN State Team Qualifier ENTRY FORM
Tournament Date(s): _August 11th and August 12th_________________________
Tournament Lake: _Conchas Lake______________________________________
Boater(“Pro”) Name: (Print)_____________________________________________________
Phone : ___________________ (email): ____________________________________________
NM BASS Nation Club: _________________________________________________________
Boater Signature: _______________________________________________________________
Boat Insurance
Company: _______________________ Policy #: ________________ Expiration:______
Amount of Liability: ______________________________________ (300K minimum)
Make of Boat: ______________________ Length: ______________ Color:__________
Motor manufacturer: __________________________Horse Power: _________________
Big Bass Pot (circle): Yes / No
For Tournament Official Use: Total Collected: _______________Check Number______________
DAY 1: Entry Fee: $100____ Big Bass: $10 TOTAL: $110____
DAY 2: Entry Fee: $100 ____ Big Bass: $10 TOTAL: $110____
Non-boater(“Am”) Name: (Print)_________________________________________________
Phone (H): __________________ (C): __________________
B.A.S.S #: __________________ Expiration: __________ Club represented: _________________
Big Bass Pot (circle): Yes / No
Co-Angler Signature: ______________________________________________________________
For Tournament Official Use: Total Collected: _______________Check Number_______________
DAY 1: Entry Fee: $50 ____ Big Bass: $10 TOTAL: $60____
DAY 2: Entry Fee: $50 ____ Big Bass: $10 TOTAL: $60____
Conchas Lake is off limits August 6-9. One contestant from each pair must attend the registration meeting at the American Legion Post at 6:00 p.m. on August 10th or have explicit approval from Randell Bell to be briefed before live well checks on August 11. All boats must be inspected for AIS prior to August 11 launch. Launch will be from the Corps of Engr. ramp on the south side of the dam. There is a $5 launch fee (Not a State Park ramp).
By signing this form you acknowledge the following: Neither the New Mexico B.A.S.S. Nation nor its officers will be responsible for any accidents. You are qualifying for the New Mexico B.A.S.S. Nation state team and will abide by all sponsor and B.A.S.S. Nation rules. All contestants must be NMBN members in good standing and over the age of 16 years (16 or older) at the time of the tournament.
