7th Annual Great Southern Beach Shootout    April 3rd, 4th∧ 5th, 2009

REGISTRATION FORM Use one entry per   person (copy if necessary).

FEES:   The cost to enter the GREAT SOUTHERN BEACH SHOOTOUT is $200.00   per person, which covers all hunts. Payment in full   must be sent with Registration Form. Registration Form must be filled out   COMPLETELY. HUNTS WILL BE HELD RAIN OR SHINE. NO   REFUNDS.

Please Print   Clearly in Ink or Type

Name_________________________________________________   Phone_________________________

Address______________________________________________________________________________

City / State /   Zip_______________________________________________________________________

E-mail   Address________________________________________________________________________

$200.00 per person   ?  Check or Money   Order  ?  Amount Enclosed:  $________________________

FREE KIDS HUNT

Name(s) and age(s) of Child(ren)________________________________________________________

No credit cards will be accepted. There   will be a $25.00 returned check fee.

CHECKS MUST BE RECEIVED BY Friday March 20 , 2009    AFTER THAT, ONLY CASH OR MONEY ORDERS WILL BE ACCEPTED AT THE   REGISTRATION DESK!

I acknowledge, by my signature below, that I release the   Great Southern Beach Shootout staff, organizers and individuals, all   sponsors, The Plaza Resort ∧ Spa, VolusiaCounty and the City of Daytona     Beach from any claims due to loss, accidents, fire,   theft or personal injury. I also hereby give permission to use my name and/or   photographic likeness in all forms, including but not limited to print,   broadcast, videotape, CD-ROM, electronic/online media, and any other lawful   purposes.I understand that it is against the law to have open   containers of alcohol on the beach.

Signature__________________________________________________   Date________________________

Note: If you do not sign the release, you will not be allowed to   participate in    THE GREAT SOUTHERN BEACH SHOOTOUT.

Check/money order should   be made PAYABLE TO: Mail Check/Money Order & Registration Form   to:

BELLE PEYTON 242     Tarragona Way Daytona Beach, FL32114

For more information,visitNEW website, www.gsbsdaytonahunt.com or contact:

Deyton Peyton peyton@gsbsdaytonahunt.com      386-255-4659

-or-

Ray     Leist huntmaster@gsbsdaytonahunt.com      386-428-3401

SEE YOU AT THE GREAT SOUTHERN BEACH SHOOTOUT!