Participation and Waiver Agreement

GBN Adult|College PWA - Participation and Waiver Agreement

I understand I must sign and date this agreement prior to participating in GEORGIA B.A.S.S. NATION, INC; herein referred to as GBN, tournament event, and that if I am under the age of majority in the state in which I reside, I must obtain the consent, and the signature of a parent or guardian to enter into this agreement. I represent and warrant compliance with the provisions set forth within the Adult-Participation and Waiver Agreement (PWA) Information Document available for download at GBN Adult-College Documents

My registration is not complete until GBN acknowledges receipt of, and the acceptance of this agreement, and receives the consent of my parent or guardian (if applicable), and all other necessary documents. The GBN Tournament Director or GBN Board of Directors, reserves the right to deny my participation in the tournament series or any component thereof for any reason and, upon such denial, to refund the deposit or entry fee.
Please select the correct GBN affiliation.
College Name
Enter Active College name
Club Name
Angler Club name
Club Number (6 digit number)
prepend your club # with leading zeros EX: Club# is 123, ENTER 000123; Club# is 10707, ENTER 010707

Name

First NameLast Name
Address

Address

Street Address Line 2

CityState

Zip Code
Cel/Mobile Phone #
Valid cell phoneFormat: (000) 000-0000.
Enter a valid email address:

Confirmation Emailconfirm email
**OPTION** Enter the email address of individual or representative registering your club team OR College - enter your college partner. This will ensure the individual gets a copy of this (PWA) SUBMISSION ID which is required for on-line entry. (example@example.com). DO NOT reenter your own email address
REQUIRED to be an active member of BASS.

Membership number can be found:
BASS (parent org) membership number:
BASS membership number

Do you have reason to use a boat in the ASC or CQ? Answer "YES" if you are participating as a boater OR a co-angler with a backup boat.

Are you using a borrowed boat?
**NOTE: anglers using a borrowed boat are REQUIRED to complete the "Borrowed Boat: Permission to use" form. After submission enter the submission ID below.
Borrowed Boat submission ID

**Adult State Classic Qualifiers**

(1) GBN requires; as of July 1, 2024, all competitors that operate or could operate a combustible engine powered vessel in the GBN Adult State Classic to show completion of an approved National Association of State Boating Law Administrators (NASBLA) boater safety course. This is REQUIRED per tournament year. GBN DOES NOT have the electronic storage (file) space to keep these copies on record, uploading of NASBLA boater safety course completion for GBN must be done each year.

PLEASE use the space below to upload a copy for GBN of your approved Boater Safety Course completion. This space will accept various file types including pdf, doc, docx, txt, rtf, html, jpg, jpeg, png, gif.

Normally completion certificates are or can be printed as pdf type file.
Boater Safety Course: ** GBN REQUIRED to provide proof, please upload a copy of completion.

Boater Safety Course
Cancelof

Is the person for which this PWA is entitled or executed a MINOR? (Georgia Code Title 39. Minors § 39-1-1:The age of legal majority in the state of Georgia is 18 years; until that age all persons are minors.)

THE FOLLOWING SECTION MUST BE COMPLETED BY MINOR'S PARENT OR LEGAL GUARDIAN:

I attest that I am a parent or legal guardian of the minor who this PWA is entitled or executed for, and I hereby consent to the terms of set forth herein and agree that we both shall be bound thereby.

I have read and have understood the provisions of this agreement contained in the "PWA - Participation and Waiver Agreement Information" document, and the official Tournament Rules. Documents are available for download at [gabassnationadult.com/Forms&Docs] under Adult State Classic Info packet & Tournament Rules

I understand that by signing this agreement, which contains liability and other release language, I have given up substantial rights. I have voluntarily signed this agreement.
Parent/Guardian

First NameLast Name
Address

Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian - Cell Phone #
Valid cell phoneFormat: (000) 000-0000.
Parent/Guardian - Enter Email address and verify (same email in both fields):

Confirmation Emailconfirm email
Terms and Conditions
Parent or Legal Guardian Signature

GBN reserves the right to accept or deny any entry form submitted.

You will receive a confirmation email of your submission along with a SUBMISSION ID. You or your club represenative registering the team for the ASC will need the submission ID. PLEASE ensure that a copy of the submission ID is forwarded to your rep.

If you DO NOT receive an email conformation, please check your spam folder for noreply@jotform.com.
Please verify the CAPTCHA and SUBMIT
Should be Empty: