Fort Pierce Billfish Derby Application Form
Entry Fee: $2,500.00 if paid by 12/14/07 - Late Entry: $2,750.00Please print and fax to 772-466-8066 or mail below
Please Provide Us All Your Boat Information:
Vessel name: ________________________ Hailing port: __________________
Vessel make: ________________________ Length: ______________________
Owner's Name: ___________________________________________________
Owners Address: __________________________________________________
City, State, Zip : ___________________________________________________
Owners Phone: __________________ Other Contact Phone: _______________
Owners E-mail: __________________________________________________
The above boat carries Liability Insurance. By signing the entry form, it is understood that the participating vessel carries a Comprehensive Insurance policy protecting all anglers, participants, observers and crew.
Owner’s Signature: ________________________Date: ___________________Tell Us Who's In Your Team: Is this a Pink Ladies Team - ____ YES or NO ____
Captains Name: __________________________ Phone: ___________________First Mate's Name: ________________________ Phone: ___________________
Second Mate's Name: ______________________ Phone: ___________________
Angler #1 Name: __________________________Phone: ___________________
Angler #2 Name: __________________________Phone: ___________________
Angler #3 Name: __________________________Phone: ___________________
Angler #4 Name: __________________________Phone: ___________________
Angler #5 Name: __________________________Phone: ___________________
Angler #6 Name: __________________________Phone: ___________________
Observers Name: __________________________Phone: ___________________
Each team may bring up to 5 people to the Awards Banquet. Additional seats may be purchased at the door. By including an angler’s name to fish does not commit him to fishing or being present. It does secure a spot on your boat for them to fish if arriving late or acting as an alternate.
Make Checks Payable to :
Fort Pierce Billfish Derby
1409 Delaware Ave - Ft. Pierce, Florida - 34950
Phone 772-216-4190
You must include (by mail or e-mail) a color photo of your boat so we can get it on the website!!
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Jim@fortpiercebillfish.com
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