October 19-20 at Caney Lake, Louisiana
Official Media Bass Team Championship 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

Tournament Options

Cost
Team Championship Entry Fee - $220
Optional B.A.S.S. Team Fee - $40
Shirt Size #1 Shirt Size #2
S M L S M L
XL XXL XXXL XL XXL XXXL
$2 Extra for XXL and $3 Extra for XXXL sizes

Your Total Is:

Entry must be received by Monday before Tournament for exact T-Shirt size
Make Checks Payable to: Media Bass
Mail This Entry Form To:
Media Bass
3309 Riverview
Mesquite, TX 75181

Phone: 972-222-2207
Email

 Entry Fee Include Daily Big Bass Pot
Team Championship Entry Fee = $220
B.A.S.S. Team Fee = $40 (optional)
At Ouachita River, LA - Dec. 5-8

Official Media Bass Championship Entry Form (Enter With Credit Card)

MediaBass.com - 3309 Riverview - Mesquite, Texas 75181
(972)222-2207