Official Media Bass LA North 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:
Daniel Carter
P.O. Box 581
Stephens, AR 71764

Phone: 870-786-5091
Cell: 870-947-0311

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