The San Diego Marlin Club Annual Halibut Derby
Don Blackman Memorial
Saturday, June 5, 2003

OFFICIAL ENTRY FORM

I agree to abide by the rules and regulations of the Halibut Derby. The undersigned parties agree, for the opportunity to participate in the Marlin club Halibut Derby, on Saturday, June 5, 2004 to release, discharge, hold harmless and indemnify The San Diego marlin Club, it’s officers, directors, employees, agents from all claims, demands and causes of any kind whatsoever, including, but not limited to, all liability for property and personal injury damages of any kind, nature, known or unknown, permanent otherwise, sustained by the undersigned as an entrant in the Halibut Derby event.

Boat Name: _________________________________________________________   
CF's __________________________________

MANDATORY 'CF' NUMBERS/DOCUMENTATION NUMBERS NEEDED BY CUSTOMS

Please indicate trailerable boat ________ Trailerable _________ In Water

1. Name Phone
Address City State
Zip Signature
2. Name Phone
Address City State
Zip Signature
3. Name Phone
Address City State
Zip Signature
4. Name Phone
Address City State
Zip Signature
5. Name Phone
Address City State
Zip Signature
TOTAL ENTRIES ($50.00 per angler/$25 per Junior angler) $
ADDITIONAL DINNER TICKETS @ $5.00 EACH $
ADDITIONAL WHITE SEABASS/YELLOWTAIL JACKPOT @ $10.00 EACH $
TOTAL ENCLOSED $

Contact Cris Lahr @ (619) 225-0505 or Michael Bingham @ (858) 748-7983 for rules and regulations and further information.

You can FAX the form to 619-222-8677 and mail the check to The Marlin Club or  Mail or drop off the form and check to The Marlin Club at the address below.
Credit Cards are accepted over the phone at the Marlin Club @ 619-222-8677
Make Checks Payable to: THE MARLIN CLUB

The Marlin Club
2445 Shelter Island Drive, San Diego, CA 92106 
Club Phone: (619) 222-8677