Angler

Co-Angler

First Name *

Last Name *

Best Phone Number *

Club Name *

Club Number *

Make of Boat

PA Boat Registration #

HP

HP Rating

If rider, can you bring a boat if necessary? Yes
No

If rider, will you have a boat at the tournament site? Yes
No

For owner, do you carry required $300,000 liability insurance on your boat? Yes
No

Are you a member in good standing with PA B.A.S.S. Federation Nation? Yes
No

Are you a member in good standing with National Bass? Yes
No

Guarantee Partner

Emergency Contact

Emergency Phone Number