Official Media Bass LA North Individuals Entry Form (Enter with Credit Card)
Angler

Birthdate    
Address
City
State Zip
Phone
SSN
Email
Little League
Ages 15 and under (must be a member)
 Birthdate    
Address
City
State Zip
Phone
School
Email
Select All That Apply:
 Tournament #1 = $120 (includes Big Bass)
Tournament #2 = $120 (includes Big Bass)
Tournament #3 = $120 (includes Big Bass)
Tournament #4 = $120 (includes Big Bass)
Tournament #5 = $120 (includes Big Bass)
Tournament #6 = $120 (includes Big Bass)
 Angler Membership = $35
Little League Membership = $35 (ages 15 and under)
Your Total Is:
Mail This Entry Form To:
Greg Terzia
154 Tanner Rd.
Choudrant, LA 71227

Phone: 318-278-4498

Email
Entry Fee = $120 (includes Big Bass)
Little League = FREE (membership required)
Membership Fee = $35 per person
Membership is good for all season events