FishCrazy 2018 Spring Derby On-Line REGISTRATION $37.00
Deadline for Registration April 15, 2018
First Name
Middle Initial
Last Name
Date of Birth         
Ohio Fishing License Customer ID #
Phone Number
Email Address
Street Address
Zip Code
T-Shirt Size
Boat Name/Handle
Is Contestant a Minor?
Is Contestant 12 yo and or Younger?
If Contestant is a minor 17 and younger an adult legal guardian MUST CO-SIGN!
Co Signer First Name
Co Signer Middle Initial
Co Signer Last Name
Co Signer Relationship
Co Signer DL#
Please Initial Box that you Read and Accept the Derby Rules
By completing and paying for this entry you acknowledge you read and agree with the
Derby's Rules and Regulations.