Western Bass Club Membership Form

Spouse, children under 18, and grandchildren are also members with your paid annual dues

NEW MEMBER AND MEMBER RENEWAL FORM

NAME (please print)_________________________________________________________________

Street Address _______________________________________________________________________

City___________________________________State________________________Zip______________

Home Phone ( _____)__________________ E-mail Address ___________________________________

Spouse:__________________________ Birthday____________________

List Children______________________Birthday(s):_____________________

___________________________Birthday_________________________

___________________________Birthday_________________________

PLEASE NOTE: For renewing members, all dues paid before March 1st shall receive a five-dollar early registration discount.

New members and before March 1st dues are $35

March 1st and after dues are $40

Your signature on this application releases Western Bass Club from all claims for any injury and/or damage, personal or property, that you, members of your family, or guests may cause or sustain.

Make Checks payable to: Western Bass Club

Member Signature_____________________________________ Date_______________________

Check Number________________

Mail to: Western Bass Club
Attn.: Secretary
PO Box 58151
Renton WA, 98058