Official Media Bass TX Northeast 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)
All Season Deposit = $240 (pay $160 at each tournament)
 Tournament # = $160 Balance Payment (All Season Deposit)

Angler 1 Membership = $40
Angler 2 Membership = $40

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 = $200 (includes Big Bass)
Membership Fee = $40 per person
Membership is good for all season events