Official Media Bass TX Heartland 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 the same substitute angler twice during a season plus, any Post Season events.
Select All That Apply:
 Tournament #1 = $200 (includes Big Bass)
Tournament #2 = $200 (includes Big Bass)
Tournament #3 = $200 (includes Big Bass)
Tournament #4 = $200 (includes Big Bass)
Tournament #5 = $200 (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:
Media Bass
3309 Riverview Dr.
Mesquite, Texas 75181

Phone: 972-222-2207
Email
Entry Fee = $200 (includes Big Bass)
Membership Fee = $35 per person
Membership is good for all season events