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.

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