Prairie State Bassmasters Membership Application

Membership Application

Please fill out the following information. DO NOT LEAVE ANY BLANKS. If the question does not apply, please respond with NOT APPLICABLE. You will receive an email as soon as your application has been reviewed. Thank you for your interest in our club.

Please identify and describe yourself:

First Name:

Last Name:

Middle Initial:

Address:

City:

Zip Code:

Phone Number: xxx-xxx-xxxx

Date of Birth:

Sex
Male Female

Did someone refer you to our club? If so, what is their name?

What is your email address?

Are you a current B.A.S.S. member?

Yes No

What is your B.A.S.S. membership number?

Choose one of the following options: Are you applying as a boater or a non-boater?

Boater
Non-Boater

What make and model boat do you own?

What size engine is on your boat?

Have you ever fished in a bass club?

Yes No

Please list the names of any clubs you have been involved with in the past.

Have you ever competed in a fishing tournament?

Yes No

How would you rate your bass fishing skills?

beginner needs improvement average better than average I'm a pro

Please tell me why you would like to join Prairie State Bassmasters and what you are expecting to get out of joining our club?

Have you browsed our website and agree to the posted club rules? (Click here to read the rules)

Yes No

Would you like to leave any questions or comments regarding Prairie State Bassmasters Club?

Please be sure all questions have been answered before submitting the form. If the question does not apply to your membership, please reply with NOT APPLICABLE. Thank you.

First Name:
Last Name:
Middle Initial:
Address:
City:
Zip Code:
Phone Number: xxx-xxx-xxxx
Date of Birth:
Sex	Male Female