Chautauqua Lake Bassmasters  visit us at http://www.chaut-lakebassmasters.com

 mail to: P.O. Box 575 Celeron, N.Y. 14720-0575

Type of Membership Application
NEW $20.00 (no initiation fee) RENEWAL $20.00

BASS              Exp Date

Applications are accepted only during regular monthly meetings (First Thursday of every scheduled month). They may be brought to any regular monthly meeting or mailed, with application fee,

Name:
Address:
City: State: Zip:
Email Phone:
Occupation: Boat Owner? Yes No
Make of Boat: Motor: H.P.:

*********************** For NEW Membership applications only *********************

Sponsor's Name:
Reason For Joining:

By my signature below, I declare that, if accepted for membership in the Chautauqua Lake Bassmasters, I will support and abide by the club's by-laws, rules and regulations. I also declare that I will always conduct myself in a manner as not to bring disgrace or dishonor upon the Chautauqua Lake Bassmasters and it's members. I understand that failure to do so may result in termination of my membership and all it's benefits, without recourse.

Applicant's Signature: Date:

OFFICIAL USE ONLY

Date Dues Received: Date Applicant voted on:
    Secretary's Signature: