Plattsburgh Rotary

26th Annual Plattsburgh Rotary International Fishing Classic
2012 Official Entry Form

Friday - Sunday, June 1 - June 3, 2012

Each Team Member must complete an Entry Form

Registrant's Name*	Required.	Team Registration*	(Min. of two members)
Address 1*	Required.	Team Name
Address 2		Team Member #1 (your name)
City*	Required.	Team Member #2
State*	Required.	Team Member #3
Zip Code*	Required.Invalid format.	Team Member #4
Daytime Phone* (xxx) xxx-xxxx	Required.Format (000) 000-0000.	E-mail Address*	Invalid format. Required.
Adult Registration	Invalid format. X $40.00 =	How did you hear about the derby?
Child Registration	Invalid format. X $20.00 =
Team Registration (If applicable)	Invalid format. X $50.00 =
Total to be charged to Credit Card		* Denotes Required Fields
Charge to:		** Team Registrations must be submitted before 6 p.m. on May 31, 2012
Name on Credit Card*	Required.
Credit Card Number*	Required.Invalid format.	Three Digit Security Code*	Required.Invalid format.
Expiration*	Month Year

By clicking the SUBMIT button, I agree to abide by all of the Rules & Regulations of the 2012 Fishing Classic.