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| Angler 1 Birthdate Address City State Zip Phone SSN 2006 Membership Fee |
Angler 2 Birthdate Address City State Zip Phone SSN 2006 Membership Fee |
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Lake - Date ----- Total $ Enclosed
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| Mail This Entry Form To: Allen Stephens 2766-A Old Richton Rd. Petal, MS 39465 Phone: 601-624-6647 |
Entry Fee = $150 per team Membership Fee = $30 per person Membership is good for all 2006 season events |