Operation Tip-Up Registration Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Registration Type* Adult Child (15 and Under) Family Family is 2 parents with up to 3 children(15 and under)Child Name First Last Must be under 15Parent 1 Name First Last Parent 2 Name First Last Child 1 Name First Last Child 2 Name First Last Child 3 Name First Last Waiver* I consent to this Waiver - Releasing all liability I know that ice fishing and ice related activities in an event is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, the effects of the weather, traffic and the conditions of the road and parking lot, conditions of ice, drowning, and all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry to participate in this event on Shawano Lake, WI. I, intending to be legally bound, do hereby for myself, my heirs, my executors and administrators agree as follows: 1. I do waive and forever release any and all rights and claims for any damages and liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting and holding the Event, including but not limited to 4th HOOAH WI, Outfitters for Patriots, all sponsors, volunteers and vendors of the event, their agents, successors, representatives and assigns even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. 2. I assume the risk of all bodily injuries, including death, resulting there from, and personal injuries to me and damage to and loss of my property, including loss of use thereof and any other indirect or consequential damages, resulting directly or indirectly, wholly or in part, from my participation in the Event and while traveling to and from the Event. 3. I hereby agree, for myself and/or for a minor under the age of eighteen for whom I am signing, to indemnify, defend, and hold the entities named above harmless from and against any and all claims, liabilities, losses and damages, costs, expenses (including attorney’s fees) judgments and penalties arising out of any of my, and or said minors, acts or omissions to act: 4. I understand that the Event reserves the right to use any and all participant’s names and/or likeness with regard to promotional and/or advertising materials. 5. I understand that all entry fees are non-refundable. Total $0.00 Credit CardCard Details Cardholder Name Δ