Family Bass Fishing Derby Entry Form, Saturday, July 20, 2019, 36th Annual Culver Lake Fest
Please submit this form and your payment online (preferred). If you are unable to submit it online, please print out this form and bring it to the derby. If you have questions, contact the Derby Director, Bill Banghart, at (219) 575-0901 or at


Registration: 5:30 AM – Public Landing (West Shore)
Fishing: 6:30 AM (Lake Maxinkuckee)
Weigh-in: 12:30 PM (East Pavilion/Courtesy Pier, Town Park)

We have made every effort to make this a “family-friendly” tournament and will continue that tradition. Therefore, we again will not limit the number of people fishing on any boat. The $50 entry fee covers the cost for all people fishing from one boat. We weigh 5 fish maximum per boat.

We will start fishing at 6:30 AM and stop at 12:30 PM. Boat registration and live-well check will start at 5:30 AM at the public boat ramp on the west side of Lake Maxinkuckee. Weigh-in will be at the East Pavilion in the Culver Town Park, access will be via the Courtesy Pier located just lakeside of the pavilion.

Overflow Parking Available for an Additional $5.00
Cash Payout and Prize Packages Details at Registration

Email address *
Please read and agree to the above Rules and Regulations. *
Entry# (leave blank if unknown):
Your answer
Boat Registration#: *
Your answer
Boat Owner's Name: *
Your answer
Boat Owner's Address, City, State, Zip: *
Your answer
Boat Owner's Phone Number: *
Your answer
Fishing Partner's Name:
Your answer
Fishing Partner's Address:
Your answer
Fishing Partner's Phone Number:
Your answer
Fishing Partner's Email:
Your answer
The $50 entry fee covers the cost for all people fishing from one boat. Please choose your method of payment: *
Damages & claims: All contestants will abide by the rules and all state and local laws. I hereby waive and release from all claims for injury and/or damage incurred in connection with this event. Boat owner/operator assumes responsibility for all contestants on his/her watercraft. I agree with these terms and conditions by signing below. Signature of boat owner/operator: to sign this disclaimer, please type your full name and today's date *
Your answer
A copy of your responses will be emailed to the address you provided.
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