September 11-12 at Lake Seminole, Georgia
Official Media Bass Individual Championship Entry Form (Enter With Credit Card)
Angler 1

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Little League

Birthdate    
Address
City
State Zip
Phone
SSN
Email

Tournament Options
Quantity

Cost
Individual Championship Package - $135
(includes Entry Fee, Dinner, and T-Shirt)
)

$

Individual Championship Entry Fee - $120
(includes Big Bass each day)

 $
Championship Dinners - $10 per person
 $
Championship T-Shirts - $10 per person

 $
 
Total -

$
Make Checks Payable to: Media Bass
Mail This Entry Form To:
Media Bass
3309 Riverview
Mesquite, TX 75181

Phone: 972-222-2207
Email

 Individual Championship
Championship Package = $135
(includes entry, dinner, and T-Shirt)
Entry = $120 (includes daily Big Bass)
Dinner = $10 per person
T-Shirts = $10 per person
Little League Qualifier = FREE

Official Media Bass Individual Championship Entry Form (Enter With Credit Card)

MediaBass.com - 3309 Riverview - Mesquite, Texas 75181
(972)222-2207