Governor's Cup Walleye Entry Blank
Name____________________________
Address________________________
Phone#________________
Partner's Name__________________________
Address ___________________________
Phone#___________________________
.........................................................................$  80

Location:Indian Lake

Big Fish Pot......................................................$  10
Late Fee...........................................................$  10
Total.................................................................$______
Please send your entry fee along with your entry form to
218 Virginia Ave
Dayton, Ohio 45410

For more information call John Clark (937) 252-4947
This form provided by the Indian Lake Website. www.indianlake.com