Irish Federation of Sea Anglers

Form of Registration for

Specimen Fish Centurian Club

Tick box and return to :-

Liam Power, 17 Dermot Hurley Est., Youghal, Co Cork Phone:024/92282

Date: ………………….. Name of club: …………………………………………………..

I wish to register the under mentioned fish caught by fair angling for consideration for the Award of a Specimen Fish Medal / Centurian Club Medal under the conditions laid down by the Irish Federation of Sea Anglers.

Date Caught : Species: Weight: KGs. Length: Girth:

………………. …………. ……………… ……….. ………….

Place of Capture : Boat/Shore Line Strength Bait Used:

…………………… ………….. ………………. …………………………...

Type of scales used : Balance and Weights ( ) Steel Yard ( ) Automatic/Spring Balance ( )

DECLARATION

I _______________________________________being a fully paid up member of

_______________________________________Sea Angling Club/Association declare

that the fish of ___________(Weight) which I wish to be registered with the I.F.S.A. was

caught by fair angling and landed in accordance with the rules of the I.F.S.A. The fish was

taken while using one rod only with not more than three hooks attached to the line or trace.

Signed______________________ Witness to capture ________________________________

Address _____________________ Address _________________________________________

____________________________ _________________________________________

Date _______________________ Witness to weigh-in ________________________________

Address _________________________________

I certify that (Name)_____________________________________________________________

Address ______________________________________________________________

Is a fully paid up member of ____________________________________Sea Angling Club

And has been since (Date) ____________________________________

Signed : Club Hon Secretary or Chairman ____________________________________________

Address ___________________________________________________________________

___________________________________________________________________

CLAIMS FOR SPECIMEN/CENTURIAN MEDALS MUST BE LOGGED WITH THE FEDERATION TROPHY OFFICER WITHIN AT MOST, TWO MONTHS OF DATE OF CAPTURE, ACCOMPANIED BY COPY OF THE SCALES CERTIFICATE OF ACCURACY.