BURLESON BASS CLUB  

                                MEMBERSHIP APPLICATION

                                                            DATE__________________

NAME_____________________________________________________________

ADDRESS__________________________________________________________

CITY______________________________STATE__________ZIP_____________

ARE YOU 18 YEARS OF AGE OR OLDER?       (____) YES      (____) NO

PHONE NO.__________________CELL PHONE__________________________

E-MAIL ADDRESS__________________________________________________

I AGREE TO ABIDE BY THE BURLESON BASS CLUB CONSTITUTION, BY-LAWS

AND TOURNAMENT RULES FOR CONTINUED MEMBERSHIP IN THE BURLESON

BASS CLUB.

DATE______________       SIGNATURE_________________________________