LAKE MINNETONKA CONSERVATION DISTRICT
SPECIAL EVENT CERTIFICATION FORM

Name of Special Event: Denny’s Super 30/Wednesday Evening Bassin’   Date__________

I, ___________________________________, acknowledge receipt of a list of waters infected by exotic species of plants and animals prepared by the Lake Minnetonka Conservation District.

I also have read: a summary of Minnesota State Laws, List of Minnesota AIS infested waters, list of Zebra mussel infested waters in Iowa & Wisconsin, and Looked at U.S. Geological Survey Map, that are located at: www.dennyssuper30.com  or www.lmcd.org     Initial  ____________

Participants must fully complete and sign one of the following paragraphs.

1.       I certify that the watercraft in which I will participate in this special event will not have been in any of the listed infested waters for at least thirty (30) days prior to participation in the event: or, if the watercraft has been in such infested waters within such thirty (30) day period , it will have been completely dry (including all live wells, bilges, and other parts of the watercraft which are capable of holding water) for a period of at least five (5) consecutive days prior to participation in the event. By my signature below I acknowledge that I understand: 1) that a false certification is a crime under the ordinances of the Lake Minnetonka Conservation District (LMCD); and 2) that if the watercraft identified below is placed in infested waters within thirty (30) days prior to launching into Lake Minnetonka and is not completely dry for five (5) consecutive days during that period, I will be required by law to have the watercraft inspected and cleaned by personnel approved by the LMCD.

Name (please print) ________________________________________________________

Signature: _____________________________________Date:______________________

State of registration of Watercraft__________ Registration #______________________

----------------------------------------------------------------------------------------------------------------------------

2.       I acknowledge that the watercraft in which I will participate in this special event has been in, or may be in, infested waters within thirty (30) days prior to participation in the event and may not be completely dry) including all live wells, bilges, and other parts of the watercraft which are capable of holding water) for at least five (5) consecutive days. By my signature below I acknowledge and understand that it is a crime under the ordinances of the Lake Minnetonka Conservation District (LMCD) to participate in the event without first having the watercraft inspected and cleaned by personnel approved by the LMCD, securing a written certification from the LMCD that the watercraft has been so inspected and cleaned and provided the certification to the  organize5s of the event prior to my participation.

Name (please print) ________________________________________________________

Signature: _____________________________________Date:______________________

State of registration of Watercraft__________ Registration #______________________