Official Media Bass LA North Individuals Entry Form
Angler

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Little League
Ages 15 and under
Birthdate    
Address
City
State Zip
Phone
School
Email
Select All That Apply:
 Tournament #1 - Big Bass Option
Tournament #2 - Big Bass Option
Tournament #3 - Big Bass Option
Tournament #4 - Big Bass Option
Tournament #5 - Big Bass Option
Tournament #6 - Big Bass Option
Tournament #7 - Big Bass Option
Tournament #8 - Big Bass Option
Angler 1 Membership
Little League Membership

Your Total Is:
Mail This Entry Form To:
Dale Taylor
230 Shore Dr.
Downsville, LA 71234

Phone: 318-368-0666

 Entry Fee = $75
Big Bass Option = $10
Little League = FREE (membership required)
Membership Fee = $30 per person
Membership is good for all 2008 season events