BOATER INFORMATION:

Name: Cell Phone #:

Address:

Agency/Agency Phone #:

Agency Address:

CHECK HERE IF THE BOATER IS RETIRED LAW ENFORCEMENT

CO-ANGLER INFORMATION:

Name: Cell Phone #:

Address:

Agency/Agency Phone #:

Agency Address:

CHECK HERE IF THE CO-ANGLER IS A FAMILY MEMBER

BOAT INFORMATION:

Make: Model:

Motor Size: GA Registration #:

Color: Length:

------------------------------------------------FOR OFFICIAL USE ONLY-------------------------------------------------------------------------------

Boat #: Check In Time: Late Penalty:

Total # of Fish: # of Dead Fish: Weight Penalty:

TOTAL GROSS WEIGHT: TOTAL NET WEIGHT: BIG FISH:

2016 Police Week Bass Fishing Tournament

Registration Form

Please return this form to Jennifer Parson at jparson@wrga.gov OR 100 Watson Blvd. Warner Robins, GA 31088