Membership Application

2023 Membership Application

$40 Annual Dues (if registering online there is an additional paypal use fee of $1.50)
If using this online form, you will be required to pay immediately with Paypal. You can use either your Paypal account or pay with a credit card. If you are not able to pay through paypal, then you must print out a hard copy form and mail it in with a check. A hard copy of the membership application is located on a button on the homepage.
You must be at least 18 years old to be a member of Midweek Bass Anglers.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Spouse / Significant other

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Emergency Contact Name

First NameLast Name
Emergency Contact Phone

Area CodePhone Number
Do you own a boat?*

YesNo
Boat Information*
Boat Insurance Carrier & policy number*
Expiration date mm/dd/yyyy*
Tow Vehicle Insurance Carrier & policy number*
Expiration date mm/dd/yyyy*
Signature*
By submitting this form, you agree to be governed by the bylaws and tournament rules of the Midweek Bass Anglers of Arizona. Furthermore, you understand that false insurance coverage information may result in the immediate termination of your membership and eligibility to participate in any club function, to include cash prizes or awards.
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Annual Dues$43.53
Paypal adds a convenience fee of 4.7%

Total $0.00
Applications are not valid until payment is received.
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2023 Membership Application