Feb 6-8, 2015 - Buckboard Marina at Flaming Gorge, Wyoming

Prize Categories*
Participant Waiver
ACKNOWLEDGEMENT OF RISK
I recognize that there is an element if risk in any adventure, sport, or activity associated with the outdoors. I am
fully cognizant of the risks and dangers inherent in Ice
Fishing and Boat Fishing and have been informed of
known special hazards in such activity. A copy of a notice of such hazards is attached hereto and made a part
hereof, and I, and the adult members of my family, have
read the same. I certify that my family and I, including
minor children, are fully capable of participating in the
said activity.
Tagged Burbot- $10,000; $5,000; $1,000; $250; $100; $50
Therefore, I assume full responsibility for personal injury
to myself and /or to members of my family, or for loss or
damage to my personal property and expenses thereof as
a result of my negligence or the negligence of my family
participating in said activity except to the extent such
damage or injury may be due to the negligence of Buckboard Marina. I further understand that Buckboard Marina reserves the right to refuse any person it judges to be
incapable of meeting the rigors and requirements of participating in the Burbot Fishing Derby.
Youth Smallest Burbot (length) - $50; $35
I have read, understand, and accept the terms and conditions stated herein and acknowledge that this agreement
shall be effective and binding upon the parties during the
entire period of participation of the said activity.
Biggest Burbot - $600; $500; $400; $300; $100; $50
Smallest Burbot- $500; $400; $300
Team Total for Most Weight of Burbot- $600; $500;
$400; $300; $100; $50
Individual Total for Most Weight of Burbot- $600; $500;
$400; $300; $100; $50
Youth Biggest Burbot (length) - $100; $75; $50
*All cash & prizes based on 600 participants
Up to 40 possible winners!
Last year’s
$10,000 tagged
Burbot prize
winner!!
Feb 6-8, 2015
Team Member #1 or Individual Print Name
_______________________________________________
Signature _____________________________Date:
__
Team Member #2 Print Name _______________________
Signature _____________________________Date:
__
Sponsored by:
Buckboard Marina
Bunning Transfer Company
Team Member #3 Print Name _______________________
Signature _____________________________Date:
__
Team Member #4 Print Name _______________________
Signature _____________________________Date:
__
Parent/Guardian
*Based on 600 participants
Rules & Signup Form
1. This is a Burbot (ling) only fishing tournament. We
would recommend but not require that you release all
fish except Burbot. Fishing will start at 5:00 P.M. on
Friday February 6th, and end at 7:00 A.M. on Sunday
February 8th. Only fish caught during this time frame
will be counted. There is no limit on Burbot and all
fish caught must be kept.
2. All participants must have a valid fishing license and
follow all regulations for the Wyoming Game and Fish
concerning fishing. Any participant found to violate
any Game and Fish regulation from 5 P.M. Friday until 7 A.M. Sunday will be disqualified. The use of Live
Bait is not allowed on Flaming Gorge. If using more
than two lines (rods) through the ice you must label
them with the angler’s name. For Ice fishing the regulations say you may have up to 6 rods per license. If
cited for any regulation by a Game & Fish officer it
could end up with the whole team being disqualified.
3. Teams can register at Buckboard Marina. Each
team must have a captain. Teams can be 2 to 4 persons. For those that pre- register or those that register
at the opening ceremonies on Friday Feb.6th the entry
fees are $35 per person 16 yrs. and over, and $5 per
person 15 yrs. and under. If you register after 6:00
P.M. on Feb 6th the entry fee is $40 per adult and $5
per minor. Having an unregistered fisherman in your
party may jeopardize the validity of fish caught.
4. Burbot must be checked in and scanned for tags
every day during the scheduled check-in period. To
qualify burbot must be kept fresh and not frozen.
Any frozen or not fresh fish determined by officials
Contact Information
Phone: 307-875-6927
Fax: 307-875-6927
Email: buckboard68@hotmail.com
Team Member Info
will be disqualified. Placing burbot in a cooler will prevent freezing.
Team Member #1 or Individual Name:
______________________________________________
5. Check points for Feb 7th will be at Buckboard Marina,
and Green River Marine behind Cruel Jacks and will be
open from 8:00 A.M. to 10:00 A.M. The final check
point on Sunday Feb. 8th will be at Buckboard Marina
and open form 8:00 A.M. to 10:00 A.M. Station will
close promptly at 10:00 A.M. Only those in line at 10:00
A.M. will be entered. All late arrivals will be turned
away. It will be required to remove the tails of the burbot before leaving the check point. All fishermen may
donate their catch for the fish fry at the end of the tournament.
Address:_________________ City ____________ ST ___
6. A least 1 registered team member must attend the
Opening Meeting on Feb 6th, 2015, at 3 P.M. and 1 team
member must attend the Closing and Awards for their
winnings.
Phone # ______________________
E-mail: _______________________
Before 2-6-15
$35 _____
After 2-6-15
$40 _____
Youth 15 yrs. & under
$5 _____
Team Member #2 ______________________
Address:_________________ City ____________ ST ___
Phone # ______________________
E-mail: _______________________
Before 2-6-15
$35 _____
After 2-6-15
$40 _____
Youth 15 yrs. & under
$5 _____
Team Member #3 ______________________
7. For safety it is required that each team must have a
throw rope and ice picks. A flotation device and cleats
are also recommended along with a cell phone while ice
fishing.
Address:_________________ City ____________ ST ___
8. All team members must sign the acknowledgement of
risk and comply with all rules. Derby Committee claims
no responsibility for accidents relating to ice or road
conditions or anything else related to the Derby.
Before 2-6-15
9. Tournament officials reserve the right to conduct
checks to ensure the rules are being followed. No refunds will be made for any reason.
Phone # ______________________
E-mail: _______________________
$35 _____
$40 _____
Youth 15 yrs. & under
Team Member #4 ______________________
Address:_________________ City ____________ ST ___
Phone # ______________________
E-mail: _______________________
10. Youth must be present when weighing in their fish.
Before 2-6-15
11. It is recommended that you purchase a Recreation
Use Pass for this event.
Youth 15 yrs. & under
12. NO BOATS ALLOWED.
After 2-6-15
$35 _____
After 2-6-15
$40 _____
Total _____
Please make checks payable to Buckboard Marina and
mail to:
HCR 65 Box 100
Green River, WY 82935