Official Media Bass LA West 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:
Dale Taylor
230 Shore Dr.
Downsville, LA 71234

Phone: 318-368-0666

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