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Ac-Bass-Jon’s Membership Form 2016 Season

Application / Please Print








  • Boater:________ Non-Boater:___________


  • Boat Type:_____ HP:_____ Make:_______


  • Tow Vehicle License Number:___________


  • Boat VA Register Number:______________



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  (Doug Fitzgerald)
26 Bears Den Trail Greeenville Va 24440PH:  

Doug Fitzgerald 540-910-0078
E-Mail:  web site: (






AC-Bass-Jon’s 2016 Season  Entry Form

Please Print and Mail to

26 Bears Den Trail Greenville Va 24440


2016 Tournament Season & Open Tournament Entry Form..

Boater's / Non-Boater’s
Name: __________________________________________________________
Address: ________________________________________________________
City/State/Zip: ____________________________________________________
Phone: __________________________________________________________

Signature: _______________________________________________________

Check here if member is a Junior Angler: ______________________________

* Parental Release for Junior Angler to fish with any Bass-Jon ‘s Club Member during tournaments. .

Parents Signature: ______________________________________________

* Parental Release for Junior Angler to fish with an assigned Bass-Jon’s Member during tournaments. This means Boater and Junior Angler fish together and is not in the draw.

Boaters Name: _________________________________________________

Parents Signature: _______________________________________________

* $20.00(cash)Per Boat no more then 2 person per boat, to be given to the Tournament Director or club officer prior to Blastoff. 80% PAY BACK 20% GOING BACK TO THE CLUB!


In consideration of The AC-BASS-JON’S of , allowing me to participate in 2016 Season Tournaments and Club Classic, I acknowledge and agree as follows:

1. I have read and understand the description of the tournament and the Official Rules of this tournament. I will obey all rules and understand that any violation may result in immediate disqualification without refund of my Entry fee.

2. I understand and acknowledge that competitive fishing is a dangerous sport, the risks of which include, though not exclusively, drowning, collisions in the water, and injuries from hooks and other fishing paraphernalia. I voluntarily assume responsibility for these risks, identified and not identified, and all risk of injury or death or damage to myself or my property or to others, including spectators and their property, arising from my participation in the tournament.

3. I hereby release, discharge, and agree to hold harmless and indemnify the AC- BASS-JON’S, its, officers, directors, the host, and tournament officials and its partners, demands, actions or rights of action which are related to, arise out of, or are in any way connected with my participation in this tournament, including specifically but not limited to the negligent acts or omissions of the AC- BASS-JON’S, its officers, directors, agents and tournament officials, and its partners, and all other persons or entities associated with the tournament from any and all liability, claims, entities associated with the tournament, for any and all injury, death, illness or disease, and other damage or loss to property suffered by myself or others. In signing this document, I acknowledge and agree that if anyone is hurt or property is damaged while I am engaged in this event, I will have no right to make a claim or file a lawsuit against the AC- BASS-JON’S, its, officers, directors, agents, the host, officials and all other persons or entities associated with the tournament, even if they or any of them negligently caused the bodily injury or property damage.

4. I have sufficient health, accident and liability insurance to cover any bodily injury or property damage incurred by myself or others as a result of my participation in this event. If I have no such insurance, I represent that I am capable of paying for any and all such expenses or liability.

5. I have no past or present medication or psychological condition that might affect my participation in the tournament in I such a way as to cause harm to others or myself.

6. I give AC- BASS-JON’S permission to use my name and photograph for promotional purposes. I am currently a member in good standing of AC-BASS-JON’S of. My signature below reflects that I have read this entire document, understand it completely, understand that it affects my legal rights, and agree to be bound by its terms. References herein to “I”, “my”, “myself”, and other First-person references shall include any child or ward for whom I sign.

SIGNATURE :_________________________________________________________

SIGNATURE (Junior Angler):_____________________________________________

SIGNATURE PARENT, IF MINOR:_______________________________________

Signature Parent, If, Minor______________________________________

Augusta County Bass Jon’s

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