Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24List names of angler(s) fishing in the tournament (no limit to number of anglers): Contact Name: Contact phone: Address: City: State: Zip: Email address: Boat Name: Boat Make: Length: Homeport: Captain: Capt’s. cell: ENTRY FEE INCLUDES: Boat registration, official Derby boat kit filled with Silver Sailfish Derby burgee, two (2) cotton tournament tee shirts, Derby score sheets and fishing related goodies & gear! Dinner tickets must be purchased separately. VISA Mastercard Exp. Date Signature of Registrant: Check (payable to the West Palm Beach Fishing Club) *Tournament is limited to 50 vessels. Entries are taken on a first come, first served basis. At least one angler per boat has to be a WPBFC member in good standing to qualify for the member discount. Registrations must be received by Friday, December 16, 2016. A $300 late registration fee is applicable if full payment is not received as of this date. SORRY, NO RAIN CHECKS OR REFUNDS. AmEx Please Print Clearly WPBFC MeMBer ($1,000) or NoN-MeMBer ($1,500) eNtry Fee: $ • tWo (2) LoNg SLeeve CottoN DerBy teeS - INCLuDeD WIth eNtry: (PLeaSe CheCk SIzeS) ____ SM ____ MeD ____ Lg ____ xL ____ xxL ____ xxxL $ Late regIStratIoN Fee (aDDItIoNaL $300 aFter DeC. 16th): $ DerBy DINNer tICketS: @ $130 eaCh: $ $1,000.00 per boat for WPBFC members • $1,500.00 per boat for non members (by Dec. 16th) After Dec. 16th: $1,300 WPBFC members/ $1,800 non-members $130.00 per person for Derby dinner tickets (sold seperately) *for official use only Boat No. * Shirt sizes are not guaranteed unless entries are received by Dec. 20, 2016. Participants of the Silver Sailfish Derby enter at their own risk. By entering, I agree that the WPBFC, sponsors, committee members & all persons connected directly or indirectly with the operation of the tournament shall be exempt from any liability for loss, damage, negligence, harm or injury suffered to any participant, vessel or equipment which may occur during the tournament. All anglers aboard my boat understand the rules of the tournament & agree to abide by them. * Sorry, No rain checks or refunds. $ TOTAL REMITTED: OFFICIAL DERBY ENTRY FORM • JAN. 4-7, 2017 Hometown: ___________________________________ Hometown: ___________________________________ Hometown: ___________________________________ Hometown: ___________________________________ register online at: westpalmbeachfishingclub.org/silver-sailfish-derby.php Return this form to: Derby Entry, P.O. Box 468, WPB, FL 33402 or fax to (561) 832-2137 Hometown: ___________________________________ Hometown: ___________________________________ CCV aDD’L. LoNg SLeeve CottoN DerBy teeS @ $22 (SIzeS S,M,L & xL): • (PLeaSe INDICate NuMBer & SIzeS): ______ SM ______ MeD ______ Lg ______ xL $ aDD’L. LoNg SLeeve CottoN DerBy teeS @ $24 (SIzeS xxL & xxxL): • (PLeaSe INDICate NuMBer & SIzeS): ______ xxL ______ xxxL $ PerForMaNCe (DrI-FIt) LoNg SLeeve DerBy teeS @ $35 (SIzeS S,M,L & xL): • (PLeaSe INDICate NuMBer & SIzeS): ______ SM ______ MeD ______ Lg ______ xL $ PerForMaNCe (DrI-FIt) LoNg SLeeve DerBy teeS @ $37 (SIzeS xxL & xxxL): • (PLeaSe INDICate NuMBer & SIzeS): ______ xxL ______ xxxL $ DerBy FLexFIt CaP (Sz. S/M) @ $22 eaCh: $ DerBy FLexFIt CaP (Sz. L/xL) @ $22 eaCh: $ - 0 - 1. 2. 3. 4. 5. 6.