2026 Mike Norris Fishing Derby
Single Registration Sign Up Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Choose 1 Option Per Person
*
Adult - $30 ($5 automatic entry into 50/50 - See Ticket #'s Below)
Junior - $10 (17 & Under)
Ticket #1
Ticket #2
Ticket #3
Ticket #4
Ticket #5
Emergency Contact:
*
First Name
Last Name
Emergency Contact Phone Number:
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Please enter a valid phone number.
Acknowledgement
I understand that my registration fee (check or cash) will be collected the morning of the event. I understand I will need to check-in to the event at the Raquette Lake FD before first cast. Winner MUST be present for door prizes and 50/50 drawings. Face masks are optional at the event.
Signature
Date
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Month
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Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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WAIVER DATE
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