POTOMAC BASSMASTERS OF VIRGINIA

Membership Application

Date of Application:

Name:

Street Address:

City, State, Zip:

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Summary of fishing experience and interests:

Summary of fishing club experience, if any:

Reason for interest in joining Potomac Bassmasters:

If you own a tournament bass boat, please provide this information:

Boat Manufacturer:

Model Year:

Engine Horsepower:

Annual membership dues are $75.00, payable at a club meeting. Dues are refundable if you do not join the club after participating in three club tournaments. Email application to Rick Kortlang, rick.kortlang@verizon.net, or print and bring to a club meeting.