2025 MSSA EBASS NATIONALS ENTRY FORM

TEAM NAME

Team Name

Trail

SKIPPER DETAILS

Skipper Name

Skipper Phone Number

Skipper Emergency Contact

Skipper Address (Number and Street Name)

Skipper Suburb

Skipper Town

Skipper Province

Skipper Postal Code

Skipper Gender

Male

Female

Skipper Date of Birth

UPLOAD COC

UPLOAD COF

CO-ANGLER DETAILS

Co-Angler Name

Co-Angler Email

Co-Angler Phone

Co-Angler Emergency Contact Number

Co-Angler Address (Number and Street Name)

Co-Angler Suburb

Co-Angler Town

Co-Angler Province

Co-Angler Postal Code

Co-Angler Gender

Male

Female

Co-Angler Date of Birth

By CLICKING on the boxes below you agree that you have read, understand and accept the EBASS T&C's and more specifically:

The MSSA EBASS Indemnity Indemnity Minor Indemnity

The MSSA EBASS Grant Of Rights Grant Of Rights Minor Grant Of Rights

The 2025 MSSA EBASS Tournament Rules Rules

Both Anglers are currently registered with MSSA and EBASS