The $130.00 (per angler) entry fee includes the cost of the derby, dinner on Saturday night, AND an official Trout Derby T-Shirt. $250.00 large fish for Saturday and Sunday. Hosted by the Lakehead Lions Club. No host bar and dinner 6:00 p.m.

 

#1 Angler's Name (Team Captain)	______________________________________
Address	______________________________________
City	______________________________________
State & Zip	______________________________________
Phone	______________________________________
Dinner Choice	Please circle one:     Steak         Chicken
T-Shirt Size	Please circle one:     Med   Lg   XL   XXL   XXXL
#2 Angler's Name	______________________________________
Address	______________________________________
City	______________________________________
State & Zip	______________________________________
Phone	______________________________________
Dinner Choice	Please circle one:     Steak         Chicken
T-Shirt Size	Please circle one:     Med   Lg   XL   XXL   XXXL
I/we have completed the entry form and have submitted the total fee for participation (Lodging not included). I/we hereby release all derby officials and sponsors from all claims of injury and/or damages incurred in connection with this event, I/we agree to abide by the derby rules and the judges decision. My/our signature on this entry form signifies that I/we read and agree with the rules of the event.
Angler #1	______________________  Date:___________
Angler #2	______________________  Date:___________

Print this form and return with check to:
Shasta Lake Trout Derby
C/O Sugarloaf Cottages Resort
P.O. Box 768
Lakehead, CA 96051