Official Media Bass TX 'Super Team' Entry Form
Angler 1

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Angler 2

Birthdate    
Address
City
State Zip
Phone
SSN
Email

Team Name (i.e. The Monster Chasers or Smith Construction)
Team Website Address

Select All That Apply:
 Tournament Entry - Big Bass
Angler 1 Membership
Angler 2 Membership

Your Total Is:
Mail This Entry Form To:
Media Bass
3309 Riverview
Mesquite, TX 75181

Phone: 972-222-2207

 Entry Fee = $300 per team
Big Bass Option = $20 per team
Membership Fee = $30 per person
Membership is good for all 2008 season events