MEMBERSHIP AND ADDRESS UPDATE FORM
NOTE: This form is to be used to update an existing members information only,
* Indicates required Information

Member Name* Bassmaster Membership Number (9 digit)
Club Name* Adult Club
College Club
Youth Club
Junior Bassmaster Club
High School Club
Youth Club
At Large Member

Reason for Update:*    
Change of Address Information for an Existing Member Youth Member now in our Adult Club
Change in Club Office/Position
New Member
Remove Member from our Club Roster
 (if this is a new member, make sure you mail your Michigan BASS Nation Dues to the Michigan Membership Director shown below, with this form, DO NOT SUBMIT A NEW MEMBER ON LINE!!)

PREVIOUS INFORMATION (Please fill in as much as possible)
Address City State Zip Code
Email Address Phone Number      Cell Phone  
      
President     Secretary     Member     Youth Member

NEW INFORMATION: (Put the NEW information in the appropriate box)
Address City State Zip Code
Email Address Phone Number         Cell Phone  
   
New Position: President     Secretary     Member


(a) Submitting this form on the M.B.N. Website will only ensure the information is updated at the Michigan B.A.S.S. Nation level. 
See the information below to submit at the National B.A.S.S. level.

INFORMATION SHOULD BE SENT TO:
1. Submit a copy to your Club's Membership Person
     (PRINT the form to submit)
2. Submit to the B.A.S.S Nation** 3. Submit to the Michigan B.A.S.S. Nation*
A) Mail To:  (PRINT the form to submit, when adding a member)
          B.A.S.S. Nation
          Federation Membership Department
          3500 Bluelake Drive
          Suite 330
          Birmingham, AL 35243
A) Mail To:  (PRINT the form to submit)

Michigan B.A.S.S. Nation
Membership Director Jason Hurst
1700 Teggerdine Road  

White Lake,
 MI 48386

B) You may submit an update via the Web Site at:
          B.A.S.S. Member Services
B) You may Submit an information change via the Web Site using this form (at http://www.michiganbass.net)
C) Fax To:  (PRINT the form to submit when you are only changing information)
        
 1-205-313-0952
Any questions can be directed to BASS at 1-877-BASS USA

Any questions may be directed to Jason Hurst at MBN at 248 909-5750 or email at jhurst@michiganbass.net

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**NOTE: Your Club Membership Person may do this for you, check with them before submitting. Form Revision Date1-27-12