CENTENNIAL BASS CLUB 

MEMBERSHIP APPLICATION
NAME ________________________  SPOUSE ________________________
(PLEASE PRINT)

ADDRESS_______________________________________________________

CITY ____________________  STATE ______________  ZIP ______________

PHONE: HOME (      )_________________  WORK (      ) ________________

MOBILE (      )____________________

B.A.S.S. MEMBER NO. _________________________  EXPIRES __________

CURRENT DUES PAID _________ (YES/NO)  BOATER _________ (YES/NO)

MAKE OF BOAT __________________  LENGTH  ______________________

MAKE OF MOTOR ________________  HORSEPOWER _________________

TROLLING MOTOR DESCRIPTION ___________________________________

MAKE OF ELECTRONICS __________________________________________

INSURANCE COMPANY ________________ POLICY NO. ________________

E-Mail  ___________________________________________________________

I HAVE READ AND UNDERSTAND THE TOURNAMENT RULES. ___________
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MEMBERSHIP DUES ARE ESTABLISHED YEARLY AND SHOULD BE PAID PRIOR TO JANUARY 1ST.  PLEASE MAKE CHECKS PAYABLE TO:   CENTENNIAL BASS CLUB.  
​2017 Annual Dues: $57.00
​Mail check to: CBC, 6908 Barbuda Dr. Ft Collins CO 80525
  It is preferred that you attend one of our monthly meetings so we may meet you.

Date: ____________________