| City, State                                   Zip   | 






 
 
| NC Open Gold Panning Competition ENTRY FORM | 

 
 
| $                                                 | 
| Donation Enclosed | 
| $                                                 | 
 
 
| Waiver: In consideration of the acceptance of the entry, I agree to abide by the rules of this competition and agree to accept the decision of the judges as final. I also give permission for the use of my name and photograph in any broadcast or account of this event for any legitimate purpose. | 




 
 
| E-mail   | 

 
 
| Parent’s Signature if under age 18 | 



