April 27th, 28th& 29th, 2007

REGISTRATION FORM
Use one entry per person (copy if necessary).

FEES: The cost to enter the GREAT SOUTHERN BEACH SHOOTOUT is $200.00 per person, which covers all hunts. Payment in full must be sent with Registration Form. Registration Form must be filled out COMPLETELY. HUNTS WILL BE HELD RAIN OR SHINE. NO REFUNDS.

Please Print Clearly in Ink or Type

Name_________________________________________________ Phone_________________________

Address______________________________________________________________________________

City / State / Zip_______________________________________________________________________

E-mail Address________________________________________________________________________

$200.00 per person   –  Check or Money Order  –  Amount Enclosed:  $________________________

FREE KIDS HUNT

Name(s) and age(s) of Child(ren)________________________________________________________

No credit cards will be accepted. There will be a $25.00 returned check fee.

CHECKS MUST BE RECEIVED BY WEDNESDAY, APRIL 18, 2007
AFTER APRIL 18th, ONLY CASH OR MONEY ORDERS WILL BE ACCEPTED AT THE REGISTRATION DESK!

I acknowledge, by my signature below, that I release the Great Southern Beach Shootout staff, organizers and individuals, all sponsors, The Plaza Resort & Spa, Volusia County and the City of Daytona Beach from any claims due to loss, accidents, fire, theft or personal injury. I also hereby give permission to use my name and/or photographic likeness in all forms, including but not limited to print, broadcast, videotape, CD-ROM, electronic/online media, and any other lawful purposes.  I understand that it is against the law to have open containers of alcohol on the beach.

Signature__________________________________________________ Date________________________

Note: If you do not sign the release, you will not be allowed to participate in
THE GREAT SOUTHERN BEACH SHOOTOUT.