Official Media Bass TX Austin Individuals Entry Form (Enter With Credit Card)
Angler

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Little League
Ages 15 and under (must be a member)
Birthdate    
Address
City
State Zip
Phone
School
Email
Select All That Apply:
Tournament #1 = $110 (includes Big Bass)
Tournament #2 = $110 (includes Big Bass)
Tournament #3 = $110 (includes Big Bass)
Tournament #4 = $110 (includes Big Bass)
Tournament #5 = $110 (includes Big Bass)
Tournament #6 = $130 (includes Big Bass)
Angler Membership = $35
Little League Membership = $35
(ages 15 and under)
Your Total Is:

Mail This Entry Form To:
Make Checks Payable To:

Jason Harless
4117 FM 89
Tuscola, Texas 79562

Phone: 325-271-0888
Email

Tournaments #1 - #5
Entry Fee
= $110
(includes Big Bass)
Tournament #6
Entry Fee
= $130
(includes Big Bass)
Little League = FREE
(membership required)
Membership Fee = $35 per person
Membership is good for all season events