Prize Categories*
Participant Waiver ACKNOWLEDGEMENT OF RISK I recognize that there is an element of 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 activities. A copy of the 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 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 Youth Smallest Burbot (length) - $50; $35
Therefore, I assume full responsibility for personal injury to myself and 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 activities 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.
*All cash & prizes based on 600 participants Up to 40 possible winners!
$10,000 tagged Burbot prize winner in 2014!!
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. Team Member #1 or Individual Print Name _______________________________________________ Signature _____________________________Date:
__
Sponsored by:
Feb. 3-5, 2017
Buckboard Marina
Team Member #2 Print Name _______________________ Signature _____________________________Date:
__
Team Member #3 Print Name _______________________ Signature _____________________________Date:
__
Team Member #4 Print Name _______________________ Signature _____________________________Date:
__
Parent/Guardian License Plate #___________________________
*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 Feb. 3rd, and end at 7:00 A.M. on Sunday Feb. 5th. Only fish caught during this time frame will be counted. There is no limit on Burbot and all fish shall not be released alive. 2. All participants shall 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 Reservoir. 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. 3rd the entry fees are $40 per person 16 yrs. and over, and $10 per person 15 yrs. and under. If you register after 6:00 P.M. on Feb. 3rd the entry fee is $45 per adult and $10 per person 15 years and under. Having an unregistered fisherman in your party may jeopardize the validity of fish caught and lead to disqualification. 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 will be disqualified. Placing burbot in a cooler will prevent freezing. 5. Check points for Feb. 4th will be at Buckboard Marina and Green River Marine behind Cruel Jacks. They will be open from 8:00 A.M. to 10:00 A.M. The final check point on Sunday Feb. 5th will be at Buckboard Marina and open from 8:00 A.M. to 10:00 A.M. The station will close promptly at 10:00 A.M. Only those in line at 10:00 A.M. shall be allowed to enter their fish. All late arrivals shall be turned away. It will be required to remove the tails of the burbot before leaving the check point. All fishermen may
Team Member Info donate their catch, on Saturday, Feb. 4th, for the fish fry at the end of the tournament.
Team Member #1 or Individual Name: ______________________________________________
6. For safety it is required that each team must have a throw rope and ice picks. A personal flotation device and cleats are REQUIRED along with a cell phone while ice fishing.
Address:_________________ City ____________ ST ___
7. All team members must sign the acknowledgement of risk form and comply with all rules. The Derby Committee claims no responsibility for accidents relating to ice or road conditions or anything else related to the Derby.
Before 2-3-17
8. Tournament officials reserve the right to conduct checks to ensure the rules are being followed. No refunds shall be made for any reason.
Address:_________________ City ____________ ST ___
9. Youth must be present when weighing in their fish.
E-mail: _______________________
10. A USFS recreation use pass may be required for fishermen using certain areas on the Flaming Gorge NRA. It is the participant’s responsibility to be aware of those locations.
Before 2-3-17
11. If fishing with an ATV or snowmobile, an ORV/ Registration sticker may be required. It is your responsibility to make sure you are complying with all local, State and Federal regulations. 12. If there are unsafe ice conditions, open water fishing is allowed either from shore or in a boat. All participants must be wearing a personal floatation device when on the boat. Watercraft regulation: From sunset to sunrise all motorized watercraft and sailboats must display red and green combined lantern in the front of the boat and a white light aft visible 360 degrees when underway. All watercraft at anchor or adrift between sunset and sunrise must display a white light to show all around the horizon and visible for two miles.
Phone # ______________________ E-mail: _______________________ $40 _____ After 2-3-17
Youth 15 yrs. & under
$10 _____
Team Member #2 ______________________
Phone # ______________________
$40 _____ After 2-3-17
$45 _____
Youth 15 yrs. & under
$10 _____
Team Member #3 ______________________ Address:_________________ City ____________ ST ___ Phone # ______________________ E-mail: _______________________ Before 2-3-17
$40 _____ After 2-3-17
$45 _____
Youth 15 yrs. & under
$10 ______
Team Member #4 ______________________ Address:_________________ City ____________ ST ___ Phone # ______________________ E-mail: _______________________ Before 2-3-17
$40 _____ After 2-3-17
Youth 15 yrs. & under
Contact Information P: 307-875-6927 F: 307-875-6927 Email:
[email protected]
$45 _____
$45 _____ $10 _____ Total _____
Please make checks payable to Buckboard Marina and mail to: HCR 65 Box 100 Green River, WY 82935
