Borrowed Boat: Permission to Use

Boat Make / Model / Color*
Boat Manufacturer Make & Model. ex: Ranger/520 C/red
Engine Make / Model*
Engine Manufacturer Model. ex: Mercury/250
GDNR Registration number*
Must be valid and active for the current year must begin with State designation

Borrower residing at the following address:*

Borrower's Street Address

Borrower's Street Address Line 2

CityState

Zip Code
Borrower Email (example@example.com)*
**Email copy OPTION: Enter Email address of individual registering your team. This will copy the individual on this submission containing the SUBMISSION ID which is REQUIRED. (example@example.com)
Borrower Cell Phone #*
Valid Angler cell phone
Club Name*
Angler Club name
HS Name*
Enter HS name that boat is being used with
College Name*
Enter college name
Club Number*
6 digit number, prepend your club # with leading zeros EX: Club# is 123, ENTER 000123; Club# is 10707, ENTER 010707

Please select one of the following for WLI (Watercraft Liabilty Insurance).

Only one (1) of the two (2) selections below will apply:

1) The WLI coverage will be provided by the boat owner or person giving the permission to use his/her boat.

OR

2) WLI covergae will be provided by the borrower or person using the boat.
Please select ONE of the following:*

Borrower is covered by Boat owner WLI (Watercraft Liability Insurance)Borrower will provide his/her own WLI (Watercraft Liability Insurance)

Boat Owner - Upload the following: 1) boat policy declaration page showing WLI of $300,000 at minimum with active coverage dates AND 2) a letter from your insurance agent stating that [borrower's name] will have $300,000 WLI while using referenced boat. These files can be pdf or text document or scanned copy of the documents (2 are REQUIRED).*

File or scan copy
Cancelof

Borrower of Boat - provide my own WLI. Upload a WLI copy (must show coverage availability while using the borrowed boat OR a statement from your insurance agent stating you are covered with $300,000 WLI while using the borrowed boat.*

File or scan copy
Cancelof

Boat Owner Signature - GBN reserves the right to contact boat owner at the phone number or email referenced in this form with questions concerning this matter. Please SUBMIT after all info & signatures have been obtained.*

Clear
Please verify the CAPTCHA and SUBMIT*
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