Official Media Bass Texas CenTex Teams Entry Form (Enter With Credit Card)
Angler 1

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Angler 2

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Select All That Apply:
 Tournament #1 = $160 (includes Big Bass)
Tournament #2 = $160 (includes Big Bass)
Tournament #3 = $160 (includes Big Bass)
Tournament #4 = $160 (includes Big Bass)
Tournament #5 = $160 (includes Big Bass)
Tournament #6 = $160 (includes Big Bass)
Angler 1 Membership = $30
Angler 2 Membership = $30

Your Total Is:
Mail This Entry Form To:
Bobby Rachel
6007 Russell Place
Streetman, TX 75859

Phone: 972-965-4942
Email

 Entry Fee = $160 per team (includes Big Bass)
Membership Fee = $30 per person
Membership is good for all 2010 season events

Official Media Bass Texas CenTex Teams Entry Form

Full entry fee may be transferred to another tournament of same division if notified three days prior to tournament.

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