Online Registration – Trout Derby

2021 Online Registration

Registration Form

Fisherman
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Telephone
Email*
Big Trout Contest Participant
Price: $5.00 Quantity:
Type of Registration*
Early Bird Registration Discount Only Available Before April 15th
Legal Waiver

I hereby release, wave and forever discharge any and all liability, claims, and demands of whatever kind or nature against the Chambersburg Noontime Lions Club and it’s filiated 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. You will be recognized on the billboard during the Derby. If you would like to sponsor a raffle prize, please include the amount of money needed to cover that prize and you will be recognized during the raffle on Sunday. Contributions must be received by April 1st in order to receive proper recognition.In addition to a great weekend of fishing, all registered participants will receive a Trout Derby Pin, and a FREE “MTO” Coupon from our friends at Sheetz
Contribution Amount

$100 Minimum
More information on your raffle prize or who you are dedicating your fish sponsorship to.
Grand Total
$0.00
We are always trying to make our derby better, please share your ideas with us in the space below:
Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name