October 30-31 at Lake Sam Rayburn, Texas
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