USA BASSIN Membership Form
Angler #1 Contact Information
Angler #1 Name *
Please enter your name.
Your answer
Address *
Please enter your complete address
Your answer
City, State & Zip Code *
Please enter your City, State and Zip Code
Your answer
Phone Number: *
Please enter a "Cell Phone" number we will use to contact you during the tournament.
Your answer
Email: *
An e-mail address is required to pay with Credit Card
Your answer
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