Michigan B.A.S.S. Federation Nation

Junior Club Roster Form

 


Club Information
Senior Club Name
Senior Club Number
Junior Club Name
Junior Club Home Town
Contact Persons Name
Phone No.
-
Email Address
 
Address
City
State
Zip
 

Junior Club Member Information
Names Address City State Zip
1.
  Date of Birth
B.A.S.S. Number
Email Address

2.
  Date of Birth
B.A.S.S. Number
Email Address

3.
  Date of Birth
B.A.S.S. Number
Email Address

4.
  Date of Birth
B.A.S.S. Number
Email Address

5.
  Date of Birth
B.A.S.S. Number
Email Address
6.
  Date of Birth
B.A.S.S. Number
Email Address
 
Thank You for Starting a Youth Club.
 
This form can be submitted electronically or printed, filled out and mailed to:
    Michigan BASS Federation Nation
    Membership Director Camille Delikta
    24525 Panama Avenue   
    Warren, MI 48091

If you have any questions, feel free to contact one of your Youth Directors. If you have more than six Junior Bassmasters, just use more than one of these forms.