2006 Angler Registration Form
Mail to: Northwest Bass, LLC / P.O. Box 825 / Veradale, WA 99037
Please fill out the form below and return it with you annual angler registration fee.
First Name:______________________ Last Name:________________________
Address:________________________ City:____________ State:___ Zip:______
SSN:___________________________ Phone:____________________
Email Address (very helpful!):__________________________________________
Have you fished with Northwest Bass before? ( ) Yes ( ) No
Registration Type:
( )
2006 Angler Registration - Individual ($35)
( ) 2006 Family Registration
($50) (includes spouse and all minor children)
Names of family members for registration:________________________________
*** Please include a signed Release of Liability form with your Annual Angler Registration. ***
Demographic Profile: (This information is helpful in defining Northwest Bass membership to potential sponsors, and personal information will not be sold or shared with any other organization). Optional.
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Do
you own a boat: Boat Make/Model: Boat Year: Motor Manufacturer/HP/Year: Electronics Manufacturer:
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Trolling Motor Manufacturer:
Battery Manufacturer:
Tow Vehicle Make/Model:
Tow Vehicle Year:
Est. Days Per Year You Fish:
Est. Miles Per Year Traveled: |