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 that is due when you join the club. It is paid only once and is good for a lifetime.

I understand that the Cowboy Church of Ellis County 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: ___________________________________________________________