(Please print clearly - ENTER AS A TEAM!)

Minnesota Pole Benders Fishing Club, PO Box 984, Lakeville, MN 55044

1st Partner:

Name: _______________________________________________

Address: _____________________________________________

City: ______________________  State: _________  Zip: _____________

Phone  (          ) _____________________   Age:  _____

E-Mail:  _____________________________________________

Signature:   ___________________________________________

2nd Partner:

Name: ________________________________________________________

Address: ______________________________________________________

City: ______________________  State: _________  Zip: _____________

Phone  (          ) _____________________   Age:  _____

E-Mail:  _____________________________________________

Signature:   ___________________________________________