Entry Form for Private Pond Record Fish

Complete this form, print it out and mail it complete with signature to:
Cecil Baird
4700 N US Hwy 33                    Remember to include pictures with your entry.
Ligonier, IN 46767                    For questions, email Cecil at jjbaird@ligtel.com

Information about the Record Fish

Species including genus species

Date Caught          Lure or Bait Used

For Kept Fish: Weight in lbs and oz. (or decimal )  Length   Girth
For Released Fish:  
Length in inches

Name of Business with Certified Scale

Address of Business include street, city, and state

Phone Number of Business include area code

Location of Pond include city, county and state

Pond Owner Signature of Pond Owner________________

Information about the Angler

Name of Angler Please Print or Type

Street Address

City StateZIP

Phone Number include area code

Email Address
                Please verify your email address. This is how we will contact you.

      Signature:_____________________________ Date: ____________

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