Online Registration Form

Name*
First Last
Address*
Street Address City State ZIP Code
Telephone
Email*
Big Trout Contest Participant Quantity
Price: $5.00
Fish Fry Dinner Quantity
Price: $20.00
Fish Fry Dinner - $20 per person
Open to the public (Derby registration not required)
Friday, May 1st from 4-7pm
Type of Registration*
Legal Waiver

I hereby release, wave and forever discharge any and all liability, claims, and demands of whatever kind or nature against the Chambersburg Rotary Club, their affiliated sponsors and it’s affiliated partners and sponsors, including in each case without limitation, their directors, officers, volunteers, and agents, either in law or inequity, to the fullest extent permissible by law, including but not limited to damages or losses caused by the negligence, fault or conduct of any kind on their part of the released parties, including but not limited to death, bodily injury, illness, economic loss or out of pocket expenses, or loss or damage to property, which I, my heirs, assignees, next of kin and/or legally appointed or designated representatives, may have or which may herein after accrue on my behalf, which arise or may hereafter arise from my participation with the activity.
Signature*
Special Contribution*
Would you like to sponsor a fish or a raffle prize?
Please fill in an amount above ($100 minimum) and include that in your registration money. Contributions must be received by April 1st in order to receive proper recognition.
Contribution Amount

$100 Minimum
More information on your raffle prize or who you are dedicating your fish sponsorship to.
Sponsor Pass Code

If you are registering for a corporate sponsor pass, enter the code here.
Grand Total
$0.00
We are always trying to make our derby better, please share your ideas with us in the space below:
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