Name:________________________________________________________________

Residence Address:_______________________________________________________

                               _______________________________________________________

                               _______________________________________________________

Business Address:________________________________________________________

                             ________________________________________________________

                             ________________________________________________________

Daytime Phone:__________________________Cell Phone:_______________________

Boating/Fishing Data

Are you a boat Owner?_____ No?, Do you plan to purchase one in the future?______

 Boat Make_________________Model________________Horsepower_______________

Insurance Company:______________________________________________________

Type of Fishing most preferred:

         Bass________________     Crappie______________     Bream _______________

Other_________________________________________________________________

 Have you ever fished with a member of Goldenrod?_______________________

Are you a member of FLW? _________ if yes Member # please___________________

Do you agree to abide by GOLDENROD BASSMASTERS BY-LAWS?_____________________

OFFICIAL USE ONLY

 MEMBERSHIP DUES PAID_______________ TOURNAMENT RULES EXPLAINED__________

Copy of By-Laws Issued________________  FLW Verified___________________

Approved by__________________________Date___________

                        Tournament Chairman

Approved by_________________________Date____________

                              President