10th Annual Wine, Women & Fishing

Ladies Only Charity Billfish Tournament

August 18-19, 2012

Sponsored by the Chesapeake Bay Wine Classic Foundation

In Partnership with the Virginia Beach Billfish Tournament

Supporting the EVMS Foundation for Breast Cancer Research

Registration fee is $700 per team. Entry fee covers up to six lady anglers, team invitation to the Tournament Registration, six tickets to the all-inclusive Awards Banquet and a goodie bag and t-shirt for each angler.

Entry fee must be received by July 15, 2012. Entry fee after July 15 is $800.

Please complete this form and mail to: CBWC/Wine, Women and Fishing

P.O. Box 1175

Virginia Beach, Virginia 23451

Please make checks payable to: Chesapeake Bay Wine Classic Foundation (CBWCF)

 VISA  MC  AMEX Name as it appears on credit card ______

Card Number ______Exp. Date______

Team Information:

Team Name: ______Sponsor: ______

Boat Name: ______Charter: Yes No

Team Contact: ______Phone: ______

E-mail: ______

Please list the anglers on your team. All anglers must be listed to participate in the tournament.

Any changes to the team (Boat, Anglers and Captain) must be made by August 19, 2012 or prior to leaving the dock.

1.  Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-Mail: ______

2.  Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-mail: ______

3. Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-mail: ______

4.  Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-mail: ______

5.  Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-mail: ______

6.  Angler Name: ______

Mailing Address: ______

City, State and Zip: ______

Phone: ______T-Shirt Size: S M L XL 2XL

E-mail: ______

Boat Information:

Name of Boat: ______Make: ______Length: ______

Captain: ______Phone: ______

Address: ______

City, State & Zip ______

Owner:( if not captain) ______

**Where are you docking? ______

 Yes, we have a breast cancer survivor on our team! Yes, someone I love has been affected by breast cancer!