2023 SQT Boater Registration

May 7 — UPPER BAY
MAY 15 — POTOMAC RIVER
JULY 15 — CHOPTANK
SEPTEMBER 30 — DEEP CREEK LAKE

Boater Full Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Boater Email*

Cell Phone*

Chapter Club*

B.A.S.S. Number*

B.A.S.S. Expiration*

Notify me of tournament information via:*

Email
Phone Number

Boat Information

You are responsible for providing your own boat for this tournament:

Boat Year and Model*

Motor Brand*

Horsepower*

State Boat Registration Number*

Exp. Date of Insurance*

Co-Angler Linked Partner:

Co-Angler Full Name*

First Last

Club Chapter Name*

Email*

Cell Phone*

Boater Only Registration Payment

2023 State Qualifying Trail Boater Fee*

Price:

Select a Payment Method*

Credit Card
Paypal

You will be directed to PayPal to complete your PayPal payment after your select ‘Register’ at the bottom of the form.

Credit Card*

Card Details

Cardholder Name

Indicate your concurrence*

• I have acquainted myself with the Maryland BASS Nation Tournament Official Rules (See Standing Rules document dated February 1, 2023 available at www.mdbassnation.com).

• I have completed this application fully and am submitting my registration for and entry fee to the Maryland BASS Nation via the online application & payment process.

• I hereby agree to be bound by, and comply with, all tournament rules and regulations. I expressly assume all risks associated with the tournament and I hereby release the Maryland BASS Nation, the host, sponsors, tournament officials and volunteers from all claims of death, injury, and/or property damage incurred by me in connection with my participation in the tournament. The use of a polygraph test will be made available and put to use if deemed necessary. I also certify that I am a member in good standing with B.A.S.S.

• I agree to provide a current copy of my boat insurance document(s). A $300,000.00 Boating Liability minimum is required. If insurance renews during the tournament season or you purchase a new boat an updated copy must be provided to the Tournament Director, ASAP.) (If you fished last year and we have a current “unexpired” copy on file, it is not required to resend at this time). Email insurance documents to: [email protected] and [email protected]

• I understand that I am required to report tournament winnings to the IRS as taxable income, and that the Maryland Bass Nation will provide an IRS form 1099 to me if I qualify. I will completed this form fully (including my social security number), and understand that this information will only be used for the purpose of filling out IRS form 1099. The Maryland Bass Nation will safeguard this information in accordance with the privacy act of 1974.

I understand and agree to the following statements

2023 State Qualifying Trail – Boater Entry Form

Boat Information

Co-Angler Linked Partner:

Boater Only Registration Payment

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