Official Media Bass LA South 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 = $35
Angler 2 Membership = $35

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

Phone: 985-758-7939

Email

Entry Fee = $160 per team (includes Big Bass)
Membership Fee = $35 per person
Membership is good for all 2012 season events