The 21st Annual Kiwanis Special Olympics Trout Fishing Derby Registration Form
July 15, 2017 at the Wishon Reservoir, Fresno County, California.
  Name:   Email Address:
  Address:
  City:     State     Zip
  Phone (with area code): Cell (with area code):
Early Registration Fees - $20 for an Individual and $40 for a Family if made prior to July1, 2017
Late Registration Fees - $30 for an Individual and $50 for a Family if made after to July 1, 2017
Click here to view Privacy Policy regarding required information.
Name
Age
Name
Age
  Registration Fees Due:
  I am unable to participate, but would like to make a donation of: $20 $40 $50
  If you are interested in becoming a Sponsor. Please click here!

When you press Submit, you will be taken to a page where you can select to pay via PayPal.
My signature and the date below certify that I have read and understand this Registration Form, and agree to the Rules and Regulations that govern the Kiwanis Special Olympics Trout Fishing Derby. Once you press Submit, you will be taken to the PayPal Payment Page. No REFUNDS
Applicant Signature Date
Click Here So You Can Print This Application, Fill It Out,
Enclose check or money order made payable to:
Kiwanis Special Olympics Trout Fishing Derby.
and Mail it to
Kiwanis Special Olympics, P.O. Box 25058, Fresno, CA 93729