Official Media Bass LA Central Teams Entry Form
Angler 1

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Angler 2

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Select All That Apply:
 Tournament #1 - Big Bass Option
Tournament #2 - Big Bass Option
Tournament #3 - Big Bass Option
Tournament #4 - Big Bass Option
Tournament #5 - Big Bass Option
Tournament #6 - Big Bass Option
Angler 1 Membership
Angler 2 Membership

Your Total Is:
Mail This Entry Form To:
Tanner Pourciau
5506 Neubig Dr.
Jarreau, LA 70749

Phone: 225-955-2460

 Entry Fee = $150 per team
Big Bass Option = $10 per team
Membership Fee = $30 per person
Membership is good for all 2008 season events