PREMIER BASS MEMBERSHIP 2008

FIRST NAME ___________(MI)_______LAST ______________________

SSN# _____________________________

ADDRESS ___________________________________________

CITY ______________________________ STATE _______________

ZIP ___________________ TELEPHONE# ___________________

BOATER/ NAME __________________________NON-BOATER/ NAME_________________________

ALTERNATE/NAME____________________________ MEMBERSHIP PER PERSON $35.00

CHECK#___________ CASH_____________EMAIL:____________________________

Mail checks to: Premier Bass - 2020 Alder St., Caldwell, Idaho 83605

PREMIER BASS MEMBERSHIP 2008

FIRST NAME ___________(MI)_______LAST ______________________

SSN# _____________________________

ADDRESS ___________________________________________

CITY ____________________________ STATE _______________

ZIP ______________ TELEPHONE# ___________________

BOATER/ NAME __________________________NON-BOATER/ NAME_________________________

ALTERNATE/NAME_____________________________ MEMBERSHIP PER PERSON $35.00

CHECK#___________ CASH_____________EMAIL:__________________________________________

Mail checks to: Premier Bass - 2020 Alder St., Caldwell, Idaho 83605

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