Cowboy Church Christian Bass Club Registration Form

Name:________________________________________________________________________________

Address: __________________________ City:____________________ State: ____   Zip:_______

Phone# __________________________________  Cell phone # ______________________________

Date of birth: __________________      Shirt size: ______________

E-mail: ___________________________________________________________________

Type tow vehicle: _____________________________ License plate: ___________________________

Boat brand: _______________________   Color: __________________  TX # __________________

Trailer license plate: __________________

Partner’s Name: ___________________________________________________________________

There is a $10 registration fee. 

I understand that the Cowboy Church Bass Club is NOT responsible for accidents, injures, or even death

while participating with this club.  I release the Cowboy Church Christian Bass Club of all responsibility.

Signature: ______________________________    Date: ___________________________

Signature of parent if under 18 yrs old: ______________________________________________________

Print and mail this form to: Reggie Stewart,   P.O. Box 61,   Forreston, TX. 76041