REGISTRATION FORM – 2023 Humminbird Lake Monduran Barra Classic (Teams Event)

Team Name *

Boat Registration (A copy of insurance for this boat is required below) *

INSURANCE – File Upload *

Please upload a current copy of insurance for the above Boat Registration. (Max File Size 8MB. Allowed File Extensions – pdf, ai, jpg, tif)

** Is considered the Team Representative who is responsible for team payment & communications **

1st Team Member – Name *

First

Last

1st Team Member – Address *

Address Line 1

City

State / Province / Region

Postal Code

1st Team Member – Phone *

1st Team Member – Email *

Terms & Conditions *

As the Team Representative, by clicking on this box, you confirm that as a team, both team members have read and agree with the 2023 Humminbird Lake Monduran Barra Classic Rules & Regulations.

Rules & Regulations – https://masa-fishstocking.org.au/?page_id=1701

2nd Team Member *

First

Last

2nd Team Member – Address *

Address Line 1

City

State / Province / Region

Postal Code

2nd Team Member – Phone *

2nd Team Member – Email *

Team Registration Fee

Price: $ 400.00

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Name