Official Media Bass LA North 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
Substitute Angler
Phone Email
Teams may use a substitute partner who has been designated prior to the teams first event of a season. This substitute may be used twice during a season and/or during Post Season events.
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 = $200 (includes Big Bass)
 Angler 1 Membership = $35
Angler 2 Membership = $35

Your Total Is:
Mail This Entry Form To:
Daniel Carter
P.O. Box 581
Stephens, AR 71764

Phone: 870-786-5091
Cell: 870-947-0311

Email
Tournaments #1 - #5
Entry Fee = $160 (includes Big Bass)
Tournament #6
Entry Fee = $200 (includes Big Bass)
Membership Fee = $35 per person
Membership is good for all season events