October 2-3 at Lake Texoma, Texas/Oklahoma
Official Media Bass Team Championship Entry Form (Enter With Credit Card)

Angler 1

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Angler 2

Birthdate    
Address
City
State Zip
Phone
SSN
Email


Tournament Options
Quantity

Cost

Team Championship Package - $200 per team
(includes Entry Fee, Two Dinners, and T-Shirts)
-

$

Team Championship Entry Fee - $170 per team
(includes Big Bass each day)

$
Championship Dinners - $10 per person
$
Championship T-Shirts - $10 per person
-

$

 
Total -

$


Make Checks Payable to: Media Bass
Mail This Entry Form To:
Media Bass
3309 Riverview
Mesquite, TX 75181

Phone: 972-222-2207
Email

Team Championship Fees
Championship Package = $200
(includes entry, two dinners, and two T-Shirts)
Entry = $170 (includes daily Big Bass)
Dinner = $10 per person
T-Shirts = $10 per person


Official Media Bass Championship Entry Form (Enter With Credit Card)

MediaBass.com - 3309 Riverview - Mesquite, Texas 75181
(972)222-2207