Official Media Bass LA North Teams Special Event 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:
 June 10 - Team Entry Fee = $200 (includes Big Bass)

Your Total Is:
Mail This Entry Form To:

Greg Terzia
154 Tanner Rd.
Choudrant, LA 71227

Phone: 318-278-4498

Email
Entry Fee = $200 (includes Big Bass)