THE GREATER WELLSVILLE TROUT DERBY
SPONSOR FORM
April 19 & 20, 2011 DERBY
    I/We will participate in the April 2011 Trout Derby as follows  ( Check One )


(    )   I/We donate $  ________________. ( Please make check payable to "Wellsville Lions Club")

(    )  I/We donate $  _________________ each for ___________ fish as a prize if the sponsored
fish is/are caught according to the rules of the Derby. I/We will not be obligated unless the fish is/are
caught. The money will be paid immediately after the contest when contacted by a Wellsville Lions
Charities Inc. or Chamber of Commerce member.

Company Name:  ____________________________________________________________

Contact Person:   _______________________________________________________

Address: _______________________________________________________________________

Telephone:  ( _____ ) _________________________________________________

Please dedicate the fish in the following manner: ( not required ).
What does this mean?  

______________________________________________________________________________


______________________________________________________________________________

Signature:
_______________________________________________________________________

Date:   __________________________________________


                                                 Thank You