ArkaTex Division Team Trail Entry Form
Team Member #1
Team Member #2
Name
DOB
Address
City
State
Zip
Phone
SSN
Email
Name
DOB
Address
City
State
Zip
Phone
SSN
Email
Lake
Date
Total $ Enclosed
Entry Fee = $150 per team . . . Membership Fee = $30 per person
Make Checks or Money Orders Payable to : Chad Cranford
Mail To : Chad Cranford - 1208 Blakely - Ashdown, AR 71822
Phone: 870-898-6296