2013 HARVESTER BASS CLUB MEMBERSHIP APPLICATION
DATE:_______________
NAME (please print)_____________________________
WIFE (Combination Membership)_________________________
Street Address
_____________________________________________
City_________________________State____________Zip__________
Home Phone MEMBERSHIP STATUS
Work Phone Regular
Cell Phone Youth
Email Address
Member Signature____________________________________
PLEASE NOTE:
ADULT MEMBERSHIP DUES ARE
$25.00
HUSBAND/WIFE COMBINATION
$35.00.
YOUTH MEMBERSHIP DUES ARE $1.00. ACTIVE DUTY MILITARY MEMBERSHIP IS FREE UPON VERIFICATION OF STATUS
YOUR MEMBERSHIP APPLICATION AND FEES MUST BE RECEIVED BY THE SECRETARY/TREASURER SEVEN (7) DAYS PRIOR TO FISHING YOUR FIRST CLUB TOURNAMENT. THERE ARE NO EXCEPTIONS TO THIS RULE, SO ALLOW PLENTY OF TIME FOR TRANSIT AND PROCESSING YOUR NEW MEMBERSHIP OR RENEWAL .
AMOUNT ENCLOSED $____________
Make your check payable to
Harvester Bass Club and send to:
CHRIS MARTIN
114
W. 21st Avenue
Coal Valley, Ill. 61240
(IF YOU ARE A NEW
MEMBER JOINING BY MAIL, PLEASE ENCLOSE A SELF ADDRESSED/STAMPED
ENVELOPE TO RECEIVE YOUR MEMBERSHIP CARD) IF YOU ARE
RENEWING MEMBERSHIP LAST YEARS CARD IS STILL YOUR MEMBERSHIP
CARD AND NO ENVELOPE WILL BE REQUIRED
************DO NOT FILL OUT LOWER PORTION*************
PAID : YES
NO
DATE RECEIVED: ________________
MEMBERSHIP NO.
_________________
WIFE NO. (Comb)________________
TREASURER INITIALS______________