First Name: * Last Name: *

Email Address *            Phone: *  

Address Line 1: *

Address Line 2:

Town: * State: * Zip: *

Location of Fish Caught:

BRCA has permission to publish the photograph for promotional purposes.

Sending in or emailing a digital photograph of your “Trophy” along with $5 buys 1 (One) Raffle ticket.
 
o   Single Raffle ticket. . . . . . $5
o   5 Raffle tickets only. . . . . $20

Please send me # raffle tickets to help raise money for the Belgrade Watershed Aquafest.

Send photos electronically to brca@gwi.net
or mail to BRCA, PO Box 250, Belgrade Lakes, Maine 04918, to be scanned and returned.