Community Fishing Addiction Nomination

Win the fishing trip of a lifetime!

Mark Berg's Fishing Addiction - Show Participation Nomination Form

As a potential winner for our show we need to find out more about you. As you can imagine the trips we do can be very demanding physically and we need to know that you can handle it. We also need to know your skill level as a fisherman and what fishing you are into. We need you to be honest in your answers, as we will reschedule with another potential winner if we find your answers to be dishonest in anyway. Good luck and thanks for watching the show.

First Name (*)
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Last Name (*)
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Street (*)
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Apt/Suite/#
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City (*)
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State (*)
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Postal Code (*)
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Daytime Phone Number (*)
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Partner's Daytime Phone Number (*)
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Email Address (*)
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1. Are you in good physical condition? (*)
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2. Do you have if any current ailments? (*)
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Please specify any current ailments
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3. Do you suffer from a mental illness? (*)
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4. What is your age? (*)
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5. Do you smoke? (*)
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6. Are you an asthmatic? (*)
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7. Do you have food allergies? (*)
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8. What sort of fishing do you normally do? (*)
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9. What is the biggest fish you have ever caught? (*)
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10. Can you cast a bait caster reel? (*)
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11.What would be your dream fish to catch? (*)
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12. Where do you reside if different to above? (*)
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13. How far are you from the nearest Capital city? (*)
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14. What are your hours of work? (*)
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15. Can you get time off work with little notice? (*)
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16. Are you happy to be seen on national television? (*)
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17. Are you happy to sign a disclaimer ?* (*)
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* Are you happy to sign a disclaimer to waver the show from any liability in regards to potential injury you may attain while traveling with our production company?
18. Tell us about you.
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Tell us why you love fishing. Tell us what it would mean to you to be chosen for the show. If you are filling out this section on behalf of someone else you must give us an insight into that person. Why do they deserve to win a place on the show? No more than 200 words please.