Wednesday Night Bassin' Entry Form (Go to LMCD Form)
Captain's Name
Membership in Denny’s Super 30 is open to all men and women. Anyone under the
age of 16 years must fish with a parent or legal guardian. Both anglers of a
team must be members. Acceptance of the prize constitutes permission for Denny's
Super 30 and its sponsors to use winner's name and/or likeness, biographical
material and/or entry (including an altered form of the entry) for advertising
and promotional purposes without additional compensation.
Social Security #
Street Address
City
State
Zip Code
Work Phone
Home Phone
E-mail
Signature
Partner's Name
Social Security #
Street Address
City
State
Zip Code
Work Phone
Home Phone
E-mail
Signature
Membership Fee (per team)
$40.00
July 21, 2010
$100.00
August 11, 2010
$100.00
Sep. 15, 2010
$100.00
TOTAL
Mail check & Signed entry form to:
DENNY’S SUPER 30
10023 120th St NW
South Haven, MN 55382
Cell 612-201-2406