To use this form be sure to make your selections first, then highlight the form between the dotted lines, download it, and mail it to the address shown.
Be sure to include your credit card number, if you are using a card! Otherwise, please enclose a check in the appropriate amount.
Fish With Me
11408 NE 29th Avenue
Vancouver, WA 98686
Name: Shirt Size:
Name: Shirt Size:
Name: Shirt Size:
Name: Shirt Size:
Your Address:
Your City: State: Zip:
Your Email: Your Phone No:
Which Location Is This Registration For? Alaska: Costa Rica: Baja-East Cape Zihuatanejo
June 15-19 Playa (Deposit $150.00 p/p) Oct 22-26 Palmas (Deposit $150.00 p/p) Alaska Aug 19-24 Highliner (Deposit $500.00 p/p) Costa Rica Sept 13-20 (Deposit $500.00 p/p) Zihuatanejo Mar 2-9,2007(Deposit $250.00 p/p)
How Many Anglers Per Room? (Check one box) 1
2
3
Number of Anglers Registering: Number of Non-fishing Adults: Number of Kids Under Age 11:
DEPOSIT INFORMATION (All information must be provided)
Check or Credit Card # Visa M/C
Exp. Date:
Name On Card: NOTE: To use your card the following information MUST be provided: Address: Zip/PC:
Total registrations on this form: Amount Enclosed With This Entry:
A deposit in the proper amount, (as shown above), for each person must accompany this form. No reservations will be made without deposit.
All Anglers and non-fishing guests release Fish With Me, Jerry Hall, Hotel Play del Sol, Hotel Palmas de Cortez, Hotel Punta Colorada, Hotel Rancho Leonero, Highliner Lodge, Roy's Zancudo Lodge, Rio Colorado Lodge, Hotel Las Brisas and their agents and sponsors from all claims of negligence or liability arising from participation. All Anglers and guests agree to waive all such liability and claims.
