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Ac-Bass-Jon’s Membership Form 2014 Season

Application / Please Print

 

Name__________________________________________________________

Address________________________________________________________

City/State/Zip____________________________________________________
2014 AUGUSTA COUNTY- BASS-JON’S of VIRGINIA
   ‘TM’

Official

Phone_________________________Cell______________________________

E-Mail__________________________________________________________

 

·         Boater:________ Non-Boater:___________

 

·         Boat Type:_____ HP:_____ Make:_______

 

·         Tow Vehicle License Number:___________

 

·         Boat VA Register Number:______________

 

SIGNATURE:_____________________________________________________

And PARENT, IF MINOR:_____________________________________________

 

If Full Membership can not be granted due to rolls being full or the Boater to Non-Boater Ratio of 2 to 1 can not be maintained with your admission. Do you wish to be placed on the Ac-Bass-Jon's Waiting List? (See By-Laws for details):  Yes____  or  NO ____.

 

Annual Dues: $30.00, Check or Money Order, Pay to the order of:
Children under the age of  16 year old Membership dues  shall be $15.00, Please  pay dues at the Meeting.
Dues are not refundable at any time. Dues will assist in the purchase of, trophies, awards and etc.

Mail to 
Augusta County Bass Jon's  Treasury  (Blaine Fitzgerald)
Po Box 176
Mt Sidney, VA 24467
PH: 540-248-5602
(home) and leave message or Doug Fitzgerald 540-910-0078
E-Mail: acbassjons@yahoo.com  web site: ( www.acbassjons.net)

 

AUGUSTA COUNTY-BASS JONS
(www.acbassjons.net)


         



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