2021 MONTANA GOVERNOR’S CUP WALLEYE TOURNAMENT APPLICATION
PLEASE PRINT & FILL OUT ALL INFORMATION COMPLETELY!
ENTRY FORM MUST BE COMPLETELY FILLED OUT TO RECEIVE TEAM NUMBER!
FIRST TEAM MEMBER:
Name _______________________________________ Social Security # ________________________
Mailing Address __________________________ City ______________ State _____ Zip _________
Home Phone # ___________________ Work # ____________________ Cell # ___________________
Email ____________________________________________ Age ______ Male Female
CHECK ONE THAT APPLIES: Adult/Child Team (under 18 years)
Mixed Couple Team (Male & Female)
Neither
SECOND TEAM MEMBER:
Name _______________________________________ Social Security # ________________________
Mailing Address __________________________ City ______________ State _____ Zip _________
Home Phone # ___________________ Work # ____________________ Cell # ___________________
Email ____________________________________________ Age ______ Male Female
ANGLER ID # (Please use your FULL MFWP/ALS # (birthdate + number) which is found on your fishing license - same from year to year)
Angler 1 # _______________________________ Angler 2 # _________________________________
TEAM SPONSOR OR SPONSORS: _______________________________________________________
_______________________________________________________
TOURNAMENT BOAT ____________________ MOTOR MAKE AND SIZE _____________________
ADULT/CHILD TOURNAMENT/GUYS & GALS TOURNAMENT
Thursday, July 8, 2021 8:00am 12:00pm (Entry Fee: $30 per team)
Team Member Names __________________________________________________________________
__________________________________________________________________
I acknowledge that I am VOLUNTARILY participating in the Montana Governor’s Cup Walleye Tournament. In consideration of being permitted to participate in the Montana
Governor’s Cup Walleye Tournament, I do for myself, my heirs, executors, administrators and assign, hereby release and forever discharge the Montana Governor’s Cup
Walleye Tournament, the Montana Governor’s Cup Committee, Glasgow Area Chamber of Commerce and Agriculture, Inc., the tournament director, and any and all
sponsoring companies, entries, and individuals, their heirs, successors, administrators and assigns, from any and every claim, demand, actions or right of action, of whatever
kind of nature, either in law or in equity, arising from or by reason of any bodily injury or personal injuries, known or unknown, death or property damage resulting or to be
result from any accident which may occur as a result of my participation in the Montana Governor’s Cup Walleye Tournament, activity or any activities, in connection with the
Montana Governor’s Walleye Tournament, whether by negligence or otherwise.
I further release all officials, staff, volunteers, participating sponsors companies and agencies from any claim whatsoever on account of first aid, treatment or service rendered
me during my participation in the Montana Governor’s Cup Walleye Tournament. This release contains the entire agreement between the parties hereto, and the terms of
this release are contractual and not a mere recital.
I HAVE READ THE RELEASE OF LIABILITY, PARTICIPANT AGREEMENT CAREFULLY AND UNDERSTAND ALL OF ITS TERMS AND CONDITIONS. I SIGN UP VOLUNTARILY AND
WITHOUT ANY RESERVATIONS.
SIGNATURE OF FIRST TEAM MEMBER ____________________________________________________________ DATE _______________________
SIGNATURE OF SECOND TEAM MEMBER ________________________________________________________ DATE _______________________
LEGAL GUARDIAN SIGNATURE (IF APPLICABLE) _____________________________________________________ DATE _______________________
MAKE CHECKS PAYABLE TO: MT Gov Cup
PO Box 832
Glasgow, MT 59230
OVER
Walleye Tournament 2021
I, the undersigned, do hereby grant to Montana Governor’s Cup, Board of Directors at the Glasgow Area Chamber of
Commerce, its employees, officers, agents, representatives, trustees and assigns [“MT Gov Cup”] my permission to record my
photographic image (by film and/or video), and comments (by tape and/or transcription), together with the right to use,
publish, copyright and reproduce in whole or in part any such photographic images and comments as described above for use
in promotional materials, whether the use of above materials be for public relations, recruitment, development, or any other
legitimate purpose of The Montana Governor’s Cup. I hereby waive any right that I may have to inspect or approve any such
photographic images and comments or completed products which incorporate all or part of any such photographic images and
comments. I hereby voluntarily release and hold harmless Montana Governor’s Cup from any and all liability arising out of or
in any way related to the use of such photographic images and comments, including but not limited to any liability arising by
virtue of any blurring, distortion, alteration, illusion, editing, or use in composite form, whether intentional or otherwise, that
may occur in the making or processing of the finished product.
SIGNATURE OF FIRST TEAM MEMBER ____________________________________________________________ DATE _______________________
SIGNATURE OF SECOND TEAM MEMBER ________________________________________________________ DATE _______________________
LEGAL GUARDIAN SIGNATURE (IF APPLICABLE) _____________________________________________________ DATE _______________________
REGISTRATION DAY NOVEMBER 1, 2020
Will accept credit card payments on opening day by walk-ins, fax or email.
There is a 4% credit card convenience fee!! No phone-ins!
34th Annual
July 8, 9, 10, 2021
Fort Peck, Montana
VISIT: www.montanagovcup.com
CALL: 406.228.2222
SIGN BOTH SIDES
CHECK THE OPTIONS TO BE INCLUDED
ENTRY FEE: $300 MUST accompany application
DAY MONEY: May accompany registration
($100 for Friday and Saturday)
Friday - $50
Saturday - $50
BIG FISH: May accompany registration
($20 / species per day)
(Total of $80 for tournament)
FRIDAY
Walleye - $20
Northern - $20
SATURDAY
Walleye - $20
Northern - $20
Total for entry, day money,
and big fish is $480
CHECK THE OPTIONS TO BE INCLUDED
ENTRY FEE: $312 MUST accompany application
DAY MONEY: May accompany registration
($104 for Friday and Saturday)
Friday - $52
Saturday - $52
BIG FISH: May accompany registration
($20.80 / species per day)
(Total of $83.20 for tournament)
FRIDAY
Walleye - $20.80
Northern - $20.80
SATURDAY
Walleye - $20.80
Northern - $20.80
Total for entry, day money,
and big fish is $499.20
Credit Card Payment Form
Since this is a 100% payback tournament, we must charge a 4% convivence fee
when using a credit or debit card.
Note:
If just paying the $300 registration fee, the total credit card charge is $312.00
Paying the entry fee plus Day Money and Big Fish, the total credit card charge is
$499.20. See fees below.
AMOUNT __________________________________________________________________________
CREDIT CARD INFO:
CARD TYPE (Check One) VISA MASTERCARD DISCOVER
CARD NUMBER _________________________________________________________________
NAME ON CARD ________________________________________________________________
EXPIRATION DATE _______________ CVV # _________ BILLING ZIP CODE ______________
EMAIL/TEXT FOR RECEIPT ________________________________________________________
NOTE: COMPLETED form is due with application
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome