FIRST NAME
STREET ADDRESS
EXTENDED ADDRESS
CITY
STATE
ZIP
PHONE (OPTIONAL)
FAX (OPTIONAL)
E-MAIL
HOW LONG HAVE YOU BEEN DIGGING? YEARS.
BIRTH DATE (WE'RE NOT BEING NOSEY IT'S JUST THAT WE HAVE TO HAVE A PARENT OR GUARDIAN PRESENT IF THE PARTICIPANT IS UNDER 18 YEARS OF AGE).
COMMENTS:
ARE YOU WILLING TO PAY TRAVEL AND LIVING EXPENSES? (FOR PEOPLE OUTSIDE OF THE DESIGNATED AREA)? Y
N
DO YOU HAVE A PERMISSION ALREADY? Y N
IF YOU DO HAVE WHAT ARE THE AGES OF EACH HOUSE?
HOUSE 1
HOUSE 2
NOTES: YOU MUST BE AT LEAST 18 YEARS OR OLDER OR HAVE A PARENT OR GUARDIAN PRESENT DURING THE DIG, ALSO IF YOU HAVE MORE THAN
TWO LOCATION PLEASE SPECIFY THE OTHERS UNDER THE COMMENTS SECTION!
YOU MUST ALSO AGREE TO THE FOLLOWING!
I WILL NOT HOLD THE H.A.R.D.C.O.R.P. BOTTLEDIGGERS OF INDIANA,
JASON D. BLEVINS OR RICK BLEVINS RESPONSIBLE FOR ANY INJURY, DEATH OR ANY FINANCIAL, MENTAL, PHYSICAL OR ANY OTHER PAIN OR LOSS INCURRED DURING THE ABOVE MENTIONED DIGGING TIME THAT I HAVE REQUESTED Y N . (SORRY ABOUT THAT BUT JUST COVERING OUR PROVERBIAL BEHINDS!)