The 21st Annual Kiwanis Special Olympics Trout Fishing Derby Registration Form
July 15, 2017 at the Wishon Reservoir, Fresno County, California.
Please Read Rules Carefully and Good Luck
This is an Online form – No online registration after July 13.
PARTICIPANTS MAY REGISTER ON JULY 15TH UP TO 9:00 AM AT THE BOAT RAMP NEAR THE DAM.
If You Want to Print Out This Form and Send It Along With a Check or Money Order Click Here
Inquiries (559) 434-8099

Phone (with area code): *(required)
  Participant Name: *(required)
  Participant Address: *(required)    Participant Email Address: *(required)
  City:*(required)     State *(required)     Zip *(required)
  Phone (with area code): *(required)     Cell (with area code):


Early Registration Fee - $20 for an Individual if made prior to July 1, 2017
Late Registration Fee - $30 for an Individual if made after July 1, 2017
Click here to view Privacy Policy regarding required information.
  Single Registration Fee Due:
 
Family Members (registration is limited to 2 adults with a maximum of three (3) children under 16)
(Please Read Family Registration Rule #2)
Adult Names
Child Names
Child Name
 


Early Registration Fee - $40 for a Family if made prior to July 1, 2017
Late Registration Fee - $50 for a Family if made after July 1, 2017
Click here to view Privacy Policy regarding required information.
  Family Registration Fee Due:    
 
Group Registration
Name
Name
Name


Early Registration Fee - $20 for an Individual if made prior to July 1, 2017
Late Registration Fee - $30 for an Individual if made after July 1, 2017
Click here to view Privacy Policy regarding required information.
  Group Registration Fee Due:    
 
 Total Registration Fees Due:     Payment Must Be Made Via PayPal When You Submit This Form:
  Are you a first time participant:   Yes No
  I am unable to participate, but would like to make a donation of:
  How Did You Hear About Us?:     If Other:
  If you are interested in becoming a Sponsor. Please click here!

When you press Submit, you will be taken to a page where you can select to pay via PayPal.
PAYMENT VIA PAYPAL IS REQUIRED IN ORDER TO COMPLETE THE ONLINE REGISTRATION.
My name and the date below certify that I have read and understand this Registration Form, and agree to the Rules and Regulations that govern the Kiwanis Special Olympics Trout Fishing Derby. Once you press Submit, you will be taken to the PayPal Payment Page. Payment must be made prior to derby day. No REFUNDS
Applicant Name Date
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