1st Bassmasters of Sullivan County, NY
3nd Annual Richard Kappes Memorial Open Tournament

To register, print out this form, and mail it to:

Noam Freedman
1st Bassmasters of Sullivan Co.
63 Werimus Road
Woodcliff Lake, NJ 07677

To pre-pay, please include a check or money order made out to:
 1st Bassmasters of Sullivan Co. in the amount of $85.00 per boat.
This includes the $5.00 Launch Donation.

Registration the day of the event will be $105.00

 (the Lunker pool is an additional $10.00 per boat)

Boater's Name: ________________________________________________________________

Address: _____________________________________________________________________

City / State / Zip: _______________________________________________________________

Phone: _______________________________________________________________________

Email: _______________________________________________________________________

Club Affiliation: ________________________________________________________________

Boat Model: __________________________________________________________________

Length: ______________________________________________________________________

Motor HP: ___________________________________________________________________

Boat Registration #: ____________________________________________________________

Boat Insurance Carrier & Policy #:

____________________________________________________________________________

Non-Boater's Name: ____________________________________________________________

Club Affiliation: ________________________________________________________________

You will receive confirmation, including the full Rules & Guidelines for the event.
This event is Co-Sponsored by Greene County.