We Care Tournament Application

Print This Form, Fill It Out And Mail It To
Southern Indiana Marine
851 South Gardner
Scottsburg, Indiana 47170

Name
Street Address
City
State
Zip
Phone
email
Boat Year
Make
Model Name
Street Address
City
State
Zip
Phone
email
Boat Year
Make
Model

Was this boat purchased from Southern Indiana Marine?
YES      NO
Signature

Signature

2005 Lowe 180W Stinger 90 hp Mercury, Trailer and Cover
$13,995

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(In consideration for you acceptance of this entry, I hereby for myself, my heirs, executors and administrators, release and forever discharge Southern Indiana Marine, their agents, servants, representatives, successors and assignees and other bodies , corporations, firms, associations, or person from any claim for damages resulting in injury to myself or to my equipment during this event. I also agree to abide by all tournament rules and all Indiana state laws. Under 18 years of age must be so-signed by parent or guardian)