Arkansas Big Bass Bonanza Refund Request

I am unable to participate in the tournament on August 1, 2, and 3. I request a refund of my registration fee and understand my weigh-in card number will be voided.

Name (used for registration) _________________________________________

Mailing Address (used for registration)

Street ______________________________________

City ________________________________________

State ______  Zip ___________

Telephone (if we need to contact you to process refund) ___________________

Weigh-In Card Number (required to process refund) ______________________

Print and complete this form and fax to Jill Thiel at (501) 376-6517 or mail to

Arkansas Big Bass Bonanza

P.O. Box 3866

Little Rock, AR  72203