Membership Application

Post Reply
stuart
Site Admin
Posts: 6
Joined: Fri Dec 23, 2016 9:13 am

Membership Application

Post by stuart » Fri Dec 23, 2016 11:29 am

BUSH BEATERS BASS CLUB

MEMBERSHIP APPLICATION



NAME: __________________________________ DATE OF BIRTH: ____________




ADDRESS: _____________________________________________



CITY: _________________________ STATE: ________ ZIPCODE:________________



CELL PHONE: ______-______-________





EMAIL:_____________________________________



MEMBERSHIPS ARE $25.00 AND RUN FROM NOVEMBER TO OCTOBER

PRO-RATED DUES OF $15.00 CAN BE USED AFTER JULY,

BUT NO ANGLER OF THE YEAR WEIGHT WILL BE COUNTED UNLESS

THE FULL $25.00 DUES ARE COLLECTED.



AMOUNT OF DUES PAID: $__________ MEMBERSHIP YEAR: __________



BOAT OWNERS PLEASE COMPLETE THE FOLLOWING:



MAKE: ___________________ BOAT LENGTH: __________ HP: ________



AS A MEMBER IN GOOD STANDING WITH THE BUSH BEATERS BASS CLUB,

I STATE THAT I CARRY LIABILITY INSURANCE FOR MY BOAT VALID FOR

THE YEAR DATED BELOW AND WILL NOT HOLD BUSH BEATERS BASS CLUB

RESPONSIBLE FOR ACCIDENTS CAUSED BY MYSELF, PASSENGERS,

OR ANY CLUB MEMBER WHILE ATTENDING ANY BUSH BEATERS BASS CLUB

TOURNAMENTS OR FUNCTIONS.



SIGNATURE: _______________________________ DATE: ______________





DATE ACCEPTED: ______________ OFFICER: ________________________

Post Reply