NEW ONLINE TOURNAMENT PAY

Tournament Online Entry & Payment Form

The Entry fee Deadline is 5pm Eastern Time the Monday Before each event. Entries will not be accepted after the deadline.

ANGLER #1 INFO

ANGLER #2 / Alternate INFO

CHECK BOX IF ANGLER #2 IS AN ALTERNATE

Angler 1 First Name

Angler 1 Last Name

Angler 1 Street Address

Angler 1 Street Address Line 2

Angler 1 City

Angler 1 Region/State/Province

Angler 1 Postal / Zip code

Angler 1 Phone

Angler 1 Email

Angler 2 First Name

Angler 2 Last Name

Angler 2 Email

Angler 2 Street Address

Angler 2 Street Address Line 2

Angler 2 City

Angler 2 Region/State/Province

Angler 2 Postal / Zip code

Angler 2 Phone

BOAT & INSURANCE INFO

Boat Make

Boat HP

Insurance Company

Boat Length

Boat Registration #

Insurance Policy #

Amount of Coverange on Policy

By signing this agreement, I/we hereby release Western PA Team Bass Series, LLC and all its officers, agents, employees, and sponsors from any and all damages, claims, costs or expenses relating to injury or even death, of any person or property, which we may sustain or cause by reason of our participation in or in connection with any tournament or event. I/we further authorize the use of any images or likeness of our person and name(s). WPTBS is not responsible for withholding any local, state, or federal taxes from any winnings.

(By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By typing your name, you consent to be legally bound by this Agreement’s terms and conditions. You further agree that your use of a key pad, mouse, or other device to type your name. You also agree that no certification authority of other third-party verification is necessary to validate your E-Signature and that the lack of such certifications or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and WPTBS. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement)

Angler #1 Signature

Angler #2 Signature

Select a date

Tournaments Being Entered (Tournaments paid for online will be charged an extra $5 for regular events and $7 for the Championship to cover online fees. To avoid these fees pay by mail.)

Select The Tournament you wish to enter

4/2/2022 Erie / Coneaut Lake - $155

5/7/2022 Mosquito Lake - $155

6/25/2022 Shenango Lake - $155

7/16/2022 Kinzua Lake - $155

8/13/2022 Chautauqua Lake #1 - $155

8/14/2022 Chautauqua Lake #2 - $155

8/27-28/2022 Championship Mosquito Lake - $227

All 2022 Tournaments - $1157

Thanks for submitting!