Southern Kingfish Association

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First Name

Last Name

Date of Birth (mm-dd-yyyy)

Gender

T-Shirt Size

Address

City

State

Zip

Mobile Phone

Home Phone

Captain Title

Boat

Name

Est Hull Value

Make

Length

Year

Reg. #

Power Mfg.

# Motors

Total HP

Trailer Mfg

Vessel Purchase Date

Current Marine Ins. Provider

Are you interested in receiving a complimentary boat insurance quote from our partner and tournament sponsor NBOA?

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City

State

Zip

Address

I hereby acknowledge all information on this form is current and accurate