Boat Owner:
Name: _________________________
Address: _______________________
_______________________________
City : __________________________
State: __________ Zip: ____________
Social Security #: ________________
Phone :_________________________
Signature: ______________________

Make of Boat: ___________________
Horsepower: ____________________

Buddy:
Name: _________________________
Address: _______________________
_______________________________
City: ___________________________
State: _________ Zip: _____________
Social Security #: ________________
Phone: _________________________
Signature: ______________________

Annual Membership $40.00 per team
($20.00 for each new partner)

Make checks payable to:
Furnace Bay Angling Products, LLC
2057 Pulaski Highway, Ste. 3
North East, MD 21901
410 287-2662

John Uhler, Tournament Director