Plattsburgh Bass Club
Membership Application
New______________ EXP. Date___________ Dues $25.00
*Applications may be accepted by any member along with
membership dues.
Name:_________________________________________________________________
Address:______________________________________________________________
City:___________________________ State:______________ Zip:______________
Email:_________________________ Phone:________________________________
Occupation:_____________________________ Boat Owner? Y:_____ N:____
Make of Boat:_____________________ Motor:_______________ HP:_________
********* FOR NEW MEMBERSHIP APPLICATIONS ONLY *********
Sponsor Information (if any):________________________________________
Reason for Joining:__________________________________________________
By my signature below, I declare that, if accepted for membership in the Plattsburgh Bass Club,
I will support and abide by the club'sby-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 Plattsburgh Bass Club
and its members. I understand that failure to do so may result in termination of my membership
and its benefits, without recourse.
FLW Membership #:___________________________ Exp Date:____________
Applicant Signature:_________________________________________________
******************* FOR OFFICIAL USE ONLY *******************
Date Dues Received:____________________________
Date Applicant Voted On:_______________________
Secretary's Signature:__________________________
President's Signature:__________________________
