Registration Form 1Anglers Details2Primary Angler Signature3Payment ANGLER 1Name(Required) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Phone(Required)ANGLER 2Name(Required) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Phone(Required) Entry Form & Waiver of LiabilityPlease note: if a team of two (2) anglers, BOTH anglers must agree to the below information.In consideration of being allowed to participate in the Heartland Anglers Championship, I acknowledge and agree to the following: I understand the risk of injury, disability, loss or damage to person or property from the activities involved in tournament(s) fishing is significant, including the potential for permanent paralysis, illness, injury and death to a person and destruction of equipment. I also understand while complying with particular Heartland Anglers Championship rules, correct use of equipment, and personal discipline may reduce this risk. I certify that I have or will obtain prior to the tournament series, Boat Owners Liability Insurance (including coverage for third party property damage and bodily injury) with no Tournament Exclusion, having a minimum limit of at least $100,000.00 per occurrence. The insurance must be issued by a reputable insurer rated A or better by A.M. Best and Co. Upon request, Contestants will provide proof of insurance. I have been advised by Heartland Anglers of the contents of this document through my reading it, and have had the opportunity to seek legal counsel with respect to the legal effect of this document prior to signing it. I KNOWINGLY AND FREELY ASSUME ALL RISKS REFERRED TO ABOVE, AND ALL OTHER RISKS OF TOURNAMENT PARTICIPATION, BOTH KNOWN AND UNKNOWN, EVEN, WITHOUT LIMITATION, IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (AS DEFINED BELOW) OR OTHERS, AND ASSUME FULL RESPONSIBILITY FOR RISKS ARISING FROM MY PARTICIPATION IN THE TOURNAMENT(S). I willingly agree to comply with the terms and conditions for participation in any tournament of Heartland Anglers and should I observe any unusual hazard(s) in my presence or during participation which could potentially cause injury or damage to any person, I will remove myself from participation and bring such hazard(s), to the attention of the nearest Heartland Anglers official immediately. I, FOR MYSELF AND ON BEHALF OF MY HEIRS, ASSIGNEED, PERSONAL REPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Heartland Anglers, ITS AFFILIATED COMPANIES, THE OFFICERS, OFFICIALS, DIRECTORS, SHAREHOLDERS, AGENTS, CONSULTANTS, AND/EMPLOYEES OF EACH, OTHER PARTICIPANTS, AND SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND, IF APPLICABLE, OWNERS AND LESSORS OF PREMISES AND PROPERTY USED TO CONDUCT THE EVENT (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHICH I SUFFER OR WHICH I AM FOUND TO HAVE CAUSED IN WHOLE OR IN PART BY MY NEGLIGENCE OR INTENTIONAL MISCONDUCT, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES, OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW. If there are any questions raised by the judges or officials of Heartland Anglers as to my veracity in respect to my participation in any tournament, I agree to submit to a polygraph examination and understand that failure to pass the examination will result in disqualification from such tournament and potentially from Heartland Anglers at its discretion as provided by the rules of the organization. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND THE ATTACHED RULES, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY. PUBLICITY. In consideration for permission to participate in any Heartland Anglers event, I (“Contestant”) hereby grant Heartland Anglers, its assignees and/or licensees, the unconditional right to use my name, voice, image, image in video format while participating in a tournament, photographic likeness, biographical information, fishing tips and/or instructions in any medium whatsoever, including but not limited to video/audio productions, social media, merchandising, promotions, articles, and/or press releases, in connection with Heartland Anglers, without restriction as to changes or alterations at any time. I understand that I will not be entitled to receive any royalties or other compensation in connection with such use and waive my right to review the finished product. By my signature below I verify that I have read and understand the foregoing provisions.This field is hidden when viewing the formPrimary Angler Digital Signature(Required) First Last Agreement to Entry Form / Waiver of Liability(Required) I/We (angler/anglers) confirm our agreement to the 2025 rules and waiver of liability set out above for Heartland Angler and hereby declare to be a team. This field is hidden when viewing the formSignature(Required)Accepted file types: jpg, gif, png, Max. file size: 2 MB. PaymentRegistration Fee(Required) Price: Total Credit Card Cardholder Name Card Details Δ
