(Check Box)
ANGLER: (Print your name as you wish it to appear on
certificate):________________________________________
PERMANENT ADDRESS: (include country and postal
code):____________________________________________
Age if 16 or under:_____________________________
SPECIES:
(1)_____________________________
(2)_____________________________
(3)_____________________________
DATE OF CATCH:_____________________________
WEIGHT: (Estimated)
(1)_____________________________
(2)_____________________________
(3)_____________________________
PLACE OF CATCH:_____________________________
METHOD OF CATCH: (Trolling, casting, fly fishing,
etc.):_____________________________
FIGHTING TIMES:
(1)_____________________________
(2)_____________________________
(3)_____________________________
EQUIPMENT:
Rod: Make: _____________________________
Length:_________________________________
Reel: Make: _______________________ Size: ______________
Line or tippet: Make: ___________________________________
Size as stated on label: _________________________________
NAME OF LURE, FLY OR BAIT:
Catch #1:_____________________________
Catch #2:_____________________________
Catch #3:_____________________________
BOAT:
Name: _____"Peppermint Patty"_______________________
Make: ____Dorado __________ Length:_______23'_______
CAPTAIN:
Name: Captain James "Jim" Savaglio_________________
Address: 4810 Willow Ridge Terrace, Valrico, Florida 33596
WITNESSES TO CATCH: Please provide name and mailing
addresses.
(1) __________________________________________________
_____________________________________________________
_____________________________________________________
(2) __________________________________________________
_____________________________________________________
_____________________________________________________
All Grand Slam Catches, past and present, are eligible as long
as they can be documented and have been caught in a single day and in accordance
with IGFA rules. Anglers will
not have to kill their fish to be eligible, fish may be released alive.
Photographs are not mandatory but are highly desirable when available and may be
published.
Signature of angler:
_____________________________________________________________________________
Sworn before me this _______________ day of
_______________________________ 19 _____
Notary signature and seal:_____________________________
When completely filled out and signed, mail this application
with photos to:
INTERNATIONAL GAME FISH ASSOCIATION, 300 Gulf Stream Way, Dania
Beach, Florida 33004 USA
Phone: (954) 927-2628 Fax: (954) 924-4299
(This application was reproduced and taken from inshoreslam.com)