Breedlove Tournament Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2 BORDER TRAIL BASS TOURNAMENT 1ST ANNUAL MARLON BREEDLOVE 1 ON 1 (BEST OF THE BEST) CHAMPIONSHIP FINANCIAL INFORMATION AND PAYMENT DEADLINE ENTRY FEE: $170.00 DUE BY MIDNIGHT OCTOBER 8, 2025$20.00 LATE FEE AFTER OCTOBER 8, 2025 PAYMENT INFORMATION ZELLE (JIM AUSTIN-770-912-6364) CASH APP ($Jimbo22) ADD $5.00 surcharge BLAST OFF NUMBERS WILL BE DETERMINED BY TIME OF REGISTRATION TOURNAMENT MEETING AND REGISTRATION TIME: 4:00 PM LOCATION: LAKESIDE BOAT RAMP PAVILION. ANY QUESTIONS? CONTACT: JIM AUSTIN: 770-912-6364 cell FOSTER BOLTON: 404-217-4050 cell Note: if you are on a cell phone, click the highlighted phone number to call the cell number Page 1 of 2NextREGISTRATION FORM BORDER TRAIL BASS FISHING TOURNAMENT PRESENTS 1ST ANNUAL MARLON BREEDLOVE1 ON 1CHAMPIONSHIP - 2025 LAKE LOGAN MARTINLAUNCHING FROM LAKESIDE BOAT RAMPOCTOBER 11, 2025 Boater Name *FirstLastAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Home PhoneMobileMethod of Payment *--- Select Choice ---Cash AppZelleSelect Method of Payment (Note: Cash App INCLUDES a $5.00 surcharge)Quantity *Select Number of Registrations that you are purchasingTotal *Price: $0.00Terms of Service *I have read and agree to the Terms of Service Agreement listed belowBy signing this form, I confirm I have read and understand all the Tournament Rules and Eligibility requirements to Participate in this event. The Tournament Rules can be found at https://fishingwithjimaustin.com/ (website) Rule Tab. I, hereby waive and release the Border Trail, Anglers Paradise, United Professional Weekend Anglers(UPWA), sponsors, hosts, officials and other contestants participating in this event and activities from all claims of liability, resulting from Personal injury, damage, lost or stolen property while participating in this event and activities. By signing this form I agree that in the event of my involvement in a rule violation, I will abide by all rulings involving disqualification or sanctions as Imposed by Border Trail, Anglers Paradise and United Professional Weekend Anglers. I confirm that I am not a Full-time Angler and/or Fishing Guide. The Border Trail, Anglers Paradise and UPWA reserve the right to refuse or reject Applications by promptly returning an Applicant’s entry fees. By signing this form I consent to a POLYGRAPH EXAMINATION if asked to do so with exam results being final. Boater Signature * Clear Signature Date *Page 2 of 2 Mobile Boater of Submit
