2019 FishCrazy Lake Erie Walleye Derby On-Line Registration $ 37.00
Deadline for Registration April 22, 2019
First Name
Middle Initial
Last Name
Date of Birth         
Ohio Fishing License Customer ID
#(Please put NA if under 16 or over 65)
Phone Number
Email Address
Street Address
City
State
Zip Code
Is Contestant a Minor, 17 Years Oldor
Younger on Last Day of The Derby?
If Contestant is a minor 17 and younger on the last day of the Derby, June 01, 2019an
adult legal guardian MUST CO-SIGN!
Co Signer First Name
Co Signer Middle Initial
Co Signer Last Name
Co Signer Relationship
Co Signer DL#
Please Initial Box that you Read and Accept the Derby Rules
By completing and paying for this entry you acknowledge you read and agree with the
Derby's Rules and Regulations.