The 22nd Annual Kiwanis Special Olympics Trout Fishing Derby Registration Form
July 14, 2018 at the Wishon Reservoir, Fresno County, California.
Please Read Rules Carefully and Good Luck
Online form – No online registration after July 12.
Inquiries (559) 434-8099


  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 Fees - $20 for an Individual and $40 for a Family if made prior to July1, 2017
Late Registration Fees - $30 for an Individual and $50 for a Family if made after to July 1, 2017
Click here to view Privacy Policy regarding required information.
 
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
 
 
Individual and/or Group Registration
Name
Name
Name
 
  Registration Fees Due:     Payment Type: PayPal Check Money Order
  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.
My name and date below certify that I have read and agree to the Rules that govern the Kiwanis Special Olympics Trout Fishing Derby. Payment must be received prior to derby day. NO REFUNDS
Applicant Name Date
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