ENTRY FORM
Please fill out, print, and mail with payment.
Name

Street

City, State, Zip

Phone



Names of Team Members (if any):



3. Payment.
Make checks payable to
"Surf Perch Derby"
Pre-registration Fee: $25.00 per person
(Day of tournament will be $30)

Extra Breakfast Tickets $7.00 each

TOTAL



Please print this form and mail along with your payment to:

Surf Perch Derby
P.O. Box 1081
Long Beach, WA 98631