EmailMeForm
Registration Type
*
Senior - $25
Junior - $10
Family (2 Juniors & 2 Seniors) - $65
Would you like to register additional juniors? (+$5 per additional Junior)
None
1
2
3
Registration Details
Please enter the details for the primary contact
Name
*
First
Last
Gender
*
Male
Female
Email
*
Phone
*
Age
*
Home town
Angling Club
Family Registration Details
Please enter the details for the other family members
Other Family Members
*
Name
Age
Gender
2nd Senior
1st Junior
2nd Junior
1 Additional Junior
*
Name
Age
Gender
3rd Junior
2 Additional Juniors
*
Name
Age
Gender
3rd Junior
4th Junior
3 Additional Juniors
*
Name
Age
Gender
3rd Junior
4th Junior
5th Junior
Fishing Location
*
Bank
Boat - Owner
Boat - Passenger
Boat Information
Boat Owner
*
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone
*
Boat Name
*
Boat Colour
*
Length
*
Rego
*
Emergency Contact Details
In the event of an emergency please provide contact details
Contact Name
*
First
Last
Contacts Phone
*
Unique ID
Comments