GEORGIA STATE CHAMPIONSHIP QUALIFIERS PRINTED REGISTRATION FORM

Tournament Directors, please complete the following information for the top 5 finishers in any of your Tournaments (of 20 boats or more) on Georgia Lakes or Lakes in States bordering Georgia in order to qualify them for an invitation to the $15,000 Georgia State Championship in November.  Invitations will go out in September.  Please enter all information to ensure prompt mailing to qualifiers.


PLEASE PRINT THIS FORM AND SEND IT TO:

HIGHLAND MARINA RESORT

1000 SEMINOLE ROAD - LaGRANGE, GA 30240

OR FAX IT TO:  (706) 883-6641


TOURNAMENT INFORMATION

All tournament information fields must be completed for qualification

TOURNAMENT NAME
TOURNAMENT DIRECTOR 
TOURNAMENT DIRECTOR E-MAIL
DIRECTOR PHONE NUMBER
TOURNAMENT LAKE
TOURNAMENT DATE    NUMBER OF BOATS 

TOURNAMENT DIRECTOR & ASSISTANT DIRECTOR INFORMATION

All tournament directors and their assistant director qualify to fish - complete this section if you wish to compete

TOURNAMENT DIRECTOR 
TOURNAMENT DIRECTOR ADDRESS
DIRECTOR city    state     zip  
ASSISTANT TOURNAMENT DIRECTOR 
ASSISTANT DIRECTOR ADDRESS
ASSISTANT DIRECTOR city    state     zip  

TOP FIVE QUALIFIERS INFORMATION

Invitations will be mailed out to complete addresses only - if address is not available,  please submit qualifiers names which will be entered in tournament database. Qualifiers must contact the Marina directly in order to register once their names have been submitted.  NOTE:  NEW FOR 2013 - ANGLERS THAT ARE NOT ELIGIBLE INCLUDE ANGLERS THAT HAVE COMPETED AS A BOATER / PRO IN A "FLW" TOUR MAJOR OR "BASS" ELITE SERIES EVENT WITH IN 6 MONTHS IMMEDIATELY PRECEDING THE PREVIOUS YEARS GEORGIA STATE CHAMPIONSHIP;  ANY ANGLERS THAT HAVE RECEIVED ANY TYPE OF COMPENSATION AS A BASS FISHING GUIDE ON TOURNAMENT WATERS WITHIN THIRTY (30 ) DAYS BEFORE THE CURRENT YEAR'S EVENT.


FIRST PLACE

BOATER NAME 
BOATER ADDRESS
BOATER city    state     zip  
PARTNER NAME
PARTNER ADDRESS
PARTNER city    state     zip  

SECOND PLACE

BOATER NAME 
BOATER ADDRESS
BOATER city    state     zip  
PARTNER NAME
PARTNER ADDRESS
PARTNER city    state     zip  

THIRD PLACE

BOATER NAME 
BOATER ADDRESS
BOATER city    state     zip  
PARTNER NAME
PARTNER ADDRESS
PARTNER city    state     zip  

FOURTH PLACE

BOATER NAME 
BOATER ADDRESS
BOATER city    state     zip  
PARTNER NAME
PARTNER ADDRESS
PARTNER city    state     zip  

FIFTH PLACE

BOATER NAME 
BOATER ADDRESS
BOATER city    state     zip  
PARTNER NAME
PARTNER ADDRESS
PARTNER city    state     zip  

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