Captain’s Name:  __________________________________________________

 

Captain’s Birth Date:  _______________________________________________

 

Boat Name:  ______________________________________________________

 

Contact Phone:  ____________________________________________________

 

Contact Email:  ____________________________________________________

 

LEVELS TO ADD:

Level II- $1500  _               _____________

Level III- $2500                  _____________

 

TOTAL ENCLOSED             _____________

 

Make checks payable to:
Kingfish Cup, LLC
PO Box 895
Shallotte, NC  28459

*  You may also drop this entry at the Ocean Isle Fishing Center with the retail store clerk