NEW MEMBER INFORMATION

Welcome to the FRESNO BASS CLUB. We need the following information from you to update our records.

NAME:		For Office Use
ADDRESS:		Month Joined: ______________
CITY/ZIPCODE:		Status: ______________
HOME PHONE:		ID Card: ______________
CELL PHONE:		Fished with: ______________
EMAIL ADDRESS:
REFERRED BY:
FLW Membership #
Are you signing up as a Boater or Non-Boater?	q BOATER		q NONBOATER
BOAT INSURANCE COMPANY (If you signed up as a boater, you’ll need to provide proof of insurance with $300,000 liability)

ANNUAL MEMBERSHIP FEES

FRESNO BASS CLUB ANNUAL MEMBERSHIP DUES			$ 30.00
ANNUAL INSURANCE (Provided by The California Bass Federation)			$ 20.00
PAID BY: CASH	CHECK	TOTAL RECEIVED	$

SIGNED:

DATE: