2023 SQT Co-Angler Registration 2023 State Qualifying Tournament – Co-Angler Entry Form MAY 7 — UPPER BAY MAY 21 — POTOMAC RIVER JULY 15 — CHOPTANK SEPTEMBER 30 — DEEP CREEK LAKE Co-Angler Full Name* First Last Co-Angler Email* Co-Angler Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code B.A.S.S. Number* B.A.S.S. Expiration* Cell Phone*Chapter Club* I understand and agree to the following statements* Email/Website (Preferred) Phone message Linked BoaterBoater Full Name* First Last Boater Email* Cell Phone*Club Chapter Name* Rider Only Registration PaymentState Qualifying Tournament Co-Angler 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 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 Δ
