Missouri Bass Nation

Club Name

Club Number

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Contestant

Name

Address

Cell Phone Number

Date of Birth

Age

Sex

Male

Female

B.A.S.S.#

Expiration

Role

Boater

Non Boater

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Boat (Complete only if bringing boat, including if to pre fish only)

Boat (Complete only if bringing boat, including if to pre fish only)

Make

Model

Year

Length

HP Rating

Registration # (Boat Identifier)

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Motor (Complete only if bringing boat, including if to pre fish only)

Motor (Complete only if bringing boat, including if to pre fish only)

Make

Year

HP Rating

Insurance Company

Expiration Date

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Attach Copy of Boat Insurance Policy

Upload File

Copy of Current Boat Insurance Policy Enclosed

Yes

No

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Team Captain

Contestant Lodging

Form Agreement

By submitting this application, I hereby waive and release the Missouri B.A.S.S. Federation Nation, and other participants and tournament officials from all claims for injury and/or damages incurred in connection with this tournament.

MO B.A.S.S. State Championship Tournament

Individual ENTRY FORM

STATE INDIVIDUAL ENTRY FORM