KOOCANUSA RESORT AND MARINA

SIXTH ANNUAL

TROUT AND SALMON DERBY
MAY 17, 2008 – MAY 18, 2008

APPLICATIONS MUST BE RETURNED
BY MAY 16, 2008 TO BE ELIGIBLE

1) NAME_________________________________________________

ADDRESS_______________________________________________________

CITY & STATE_____________________________________ ZIP ____________

PHONE NUMBER (__________) _____________________If under 15, age_____

2) NAME_____________________________________________

ADDRESS_______________________________________________________

CITY & STATE_____________________________________ ZIP ____________

PHONE NUMBER (__________) _____________________If under 15, age_____

3) NAME________________________________________________

CITY &STATE_______________________________________ZIP____________

PHONE NUMBER (__________) ____________________If under 15, age_____

4) NAME________________________________________________

ADDRESS_______________________________________________________

CITY &STATE______________________________________ ZIP ____________

PHONE_(__________)________________________If under 15, age_____

BOAT IDENTIFICATION NUMBERS: ______________________
(THIS MUST BE BOAT THAT IS USED FOR THE DERBY)