26th Annual Rotary Club of Pittsford Trout Derby Registration Form
Saturday, May 13, 2023
Registration starts: 8am
Tournament 9-11am
Trophies awarded: 11:15am

Powder Mills Park, Powderhorn Lodge

To learn more, visit pittsfordrotaryclub.org
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First participant
First Name *
Last Name *
Age *
Second participant
Leave blank if none
First Name
Last Name
Age
Third participant
Leave blank if none
First Name
Last Name
Age
Parent/Guardian
First Name *
Last Name *
Street Address *
City *
State *
Zip *
Phone # *
Email *
How did you hear about this year's Rotary Trout Derby? (please check all that apply) *
Required
Is this your first Rotary Derby? *
Would you like to be advised of future Rotary events? *
I hereby authorize the Rotary Club of Pittsford or anyone they authorize to use photographs taken for advertising, display, competition, education and publication in all manners for any product or services, or other lawful uses as determined by the Rotary Club of Pittsford. I further waive any and all rights to review or approve any use of the images, any written copy or finished product. I have read and fully understand the terms of this release. *
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