ELKS Lodge # 1622
502 Dutchman's Lane, Easton, MD 21601
410-822-3344
www.elks1622.org
Serving Caroline and Talbot counties on Maryland's Eastern Shore
2018 -- YOUTH FISHING DERBY ON-LINE REGISTRATION
Parental Information:
Youth Information:
First Name & Last Name if Different
Age
Need Rod&Reel ?     (Yes or No)
Waiver:        The following paragraph must be read, agreed to, and signed before an individual may participate in the                            Fishing Derby. If registering electronically, this agreement must be signed at check-in the morning of the derby. 
                Do not enter information on the bottom line until the morning of the derby.
Instructions:

Erase the content of the first field and enter your first name in the parental info section. Use the Tab key to move to the next field.  If not completing a field, leave as is.

Use as many rows as necessary. If not using a row, leave field contents as is.
If you have a rod & reel suitable for pond fishing please bring & use it.-- We will have a limited number of rods & reels available to loan to youth.