Official Media Bass TX Northeast 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:
Make Checks Payable To:

Stanley Laska
12395 CR 2175
Whitehouse, TX 75791

Phone: 903-520-4587
Email
Entry Fee = $120 (includes Big Bass)      
Little League = FREE (membership required)
Membership Fee = $35 per person
Membership is good for all season events