Official Media Bass LA South Individuals Entry Form (Enter with Credit Card)
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
Angler Membership
Little League Membership

Your Total Is:
Mail This Entry Form To:
Cayce Gunter
109 Folse Street
DesAllemands, LA 70030

Phone: 985-758-7939

 Entry Fee = $100
Big Bass Option = $10
Little League = FREE (membership required)
Membership Fee = $30 per person
Membership is good for all 2009 season events