Wyoming Walleye Stampede
2017 In-State Championship
Pathfinder Reservoir
August 12th & 13th, 2017
$300 per Team(Entry Deadline Aug 9 , 2017)
th
First Member: Name_____________________Age______ SS# ________-_______-________
Address______________________________________Email___________________________
City_______________________State_____________________Zip___________
Home Phone______________________Cell/Work___________________________________
Second Member: Name___________________Age______ SS# ________-_______-________
Address________________________________Email_________________________________
City_______________________State_____________________Zip______________
Home Phone__________________________Cell/Work________________________________
We have read and understand the release of liability, participation, & photo release agreement carefully and
understand all the terms and conditions. I sign up voluntarily and without reservations.
Team member
#1 Signature_________________________________________Date_____________________
Team member
#2 Signature_________________________________________Date_____________________
Pay by credit card ($330.00ea.) Visa/MC/Discover #______________________sec code_________ exp.___
Mail applications to: Wyoming Walleye Stampede: PO Box #50472, Casper, WY. 82605-0472