SOUTHERN TIER BASSMASTERS

Membership Application

visit us at http://www.southerntierbass.com

 

TYPE OF APPLICATION:
NEW
RENEWAL		 $55.00 (includes $10.00 initiation fee)
$45.00; $55.00 if paid after December meeting		            
B.A.S.S. #
EXP. DATE
Note: All application fees include a mandatory $20 membership fee for National B.A.S.S. Federation

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Applications are accepted only during regular monthly meetings (second Wednesday of every month).
They may be brought to any regular monthly meeting or mailed, with application fee, to the address below.

Name:
Address:
City: State: Zip:
Date of Birth: Age:           Phone:
Email:
Occupation: Boat Owner? Yes No
Make of Boat: Motor: H.P.:

*********************** For NEW Membership applications only *********************

Sponsor's Name:
Reason For Joining:
By my signature below, I declare that, if accepted for membership in the Southern Tier Bassmasters, I will support and abide by the club's by-laws, rules and regulations. I also declare that I will always conduct myself in a manner as not to bring disgrace or dishonor upon the Southern Tier Bassmasters and it's members. I understand that failure to do so may result in termination of my membership and all it's benefits, without recourse.
Applicant's Signature: _______________________________________ Date:

OFFICIAL USE ONLY

Date Applicant voted on: ________________________________________
Date Dues Received: ________________________________________
Secretary's Signature: ________________________________________

mail to: P.O. Box 678, Portville, N.Y. 14770-0678