2009 BASSSOUTH MEMBERSHIP FORM

Please PRINT clearly the following information.

NAME________________________________________

ADDRESS_________________________________________

CITY____________________________STATE____________

ZIP__________________BELLSOUTH EMPLOYEE: Y__N__

PHONE_____________________ CELL_________________

EMAIL_____________________________________________


SIGNATURE________________________________________

DATE_____________________________________________

In signing this application, I waive and release all contestants, host sponsors and tournament officials from all claims of injury, loss and/or damages incurred in connection with any of the 2009 BASSSOUTH BASS TOURNAMENTS. Please fill out and bring with you on tournament day.