The Mix 107.5 Reel Fun Fishing Derby

SPECIAL NOTICE:

Representatives from the New Mexico Department of Game and Fish will be present during the Fishing Derby

TO ENSURE A FUN AND FAIR FISHING DERBY EVENT, PLEASE FOLLOW THESE RULES AND REGULATIONS:

EVENT INFORMATION:

TO ENTER THE FISHING DERBY, PLEASE COMPLETE FORM BELOW

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Date of Birth(Required)

Age(Required)

Emergency Contact(Required)

First Last

Phone(Required)

Relationship(Required)

Age Group(Required)

Ages 4-11 (No Fishing License Required)

Ages 12-17 (Valid Fishing License Required)

Ages 18 + (Valid Fishing License Required)

Enter Name (Parents/Guardian signature required for participants under 18)(Required)