SOLD
To guarantee your reservation , payment must accompany this completed form . Surf & Turf Sponsor Blue Runner Sponsor Tuna Sponsor
SOLD
Goggle Eye Sponsor Flying Fish Sponsor Bally Hoo Sponsor
SOLD
SOLD
Wahoo Sponsor Dolphin Sponsor Banner Sponsor
REGISTRATION DEADLINE : March 17 , 2017
Company Name :_____________________________________
Contact Name :___________________________________ Phone :_____________________________________ E-Mail :__________________________________________________
BOAT ENTRY + 2 ANGLERS ($ 650 each ) Boat Name : _______________________________________
Captain ’ s Name : ______________________________
Boat Type : _______________________________________ If the Captain is fishing or attending the dinner , please put their name in an Angler or Dinner Guest space below .
Shirt
Shirt
Angler Name :______________________________________ Size : Angler Name :_______________________________________
Size :
ADDITIONAL ANGLERS ($ 225 each )
Shirt
Shirt
Angler Name :_______________________________________ Size : Angler Name :________________________________________
Size :
Shirt
Shirt
Angler Name :_______________________________________ Size : Angler Name :________________________________________
Size :
Shirt
Shirt
Angler Name :_______________________________________ Size : Angler Name :________________________________________
Size :
JUNIOR ANGLER ( Age 14 and under $ 150 each )
Shirt
Shirt
Jr . Angler Name :_________________________________________ Size : Jr . Angler Name :_________________________________
Size :
BANQUET GUEST ($ 175 each ) Guest Name :_________________________________________ Guest Name :_____________________________________ Guest Name :_________________________________________ Guest Name :_____________________________________ Guest Name :_________________________________________ Guest Name :_____________________________________ Guest Name :_________________________________________ Guest Name :_____________________________________
ADDITIONAL SHIRTS …..$ 32.10 each ( Sales Tax Included ) Quantity of Shirts in Size Section below : XS _____ S _____ M _____ L _____ XL ____ 2XL _____ 3XL _____
REGISTRATION INFORMATION :
Boat Entry $ 650 x ________ = $ ___________
Add . Anglers $ 225 x ________ = $ ___________ Jr . Angler $ 150 x ________ = $ ___________ Guests $ 175 x ________ = $ ___________ Sponsorship _______________ = $ ___________ Add . Shirts $ 32.10 x _______ = $ ___________
Total Amount Enclosed = $____________
PAYMENT : ( Due with registration )
□ VISA □ MasterCard □ Amex □ Check Cardholder ’ s Name :____________________________________ Card No . :_____________________________________________ Exp . Date : ____________ Billing Zip Code :________________ Authorized Signature :
CREDIT CARD GRAND TOTAL $__________ Credit Payments add 2 % to total .
_____________________________________________________
Make Checks Payable to : AGC FEC 2617 N Australian Avenue , West Palm Beach , FL 33407
Return form to Danielle @ agcfla . build ** No refunds for weather days or cancellations after Friday , March 17 , 2017 .