West Virginia Bass Federation, Inc. - State Qualifier Registration Form

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WEST VIRGINIA BASS FEDERATION, INC.
STATE QUALIFIER REGISTRATION FORM
Club Name______________________________________________Year_________________________
Check one:
____Northern
____Central
____Southern
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Name _________________________________________________Phone__________________________
Street_________________________________________________FLW #___________________________
City, St, Zip ____________________________________________Boater______Nonboater____________
Must attach a copy of proof of insurance for each boater.
Must attach a copy of DNR Creel Report - No Exceptions!!!!
There is a mandatory pre-tournament meeting the Friday night before your
Qualifier at 8:00 p.m. (Site to be announced)
THIS FORM MUST BE RECEIVED NO LATER THAN THE MONDAY BEFORE
YOUR QUALIFIER. IF NOT RECEIVED BY THIS DATE WITH BOATER INSURANCE
CERTIFICATES AND DNR CREEL REPORTS YOUR CLUB WILL NOT BE
ELIGIBLE TO FISH THE QUALIFIER. THIS FORM IS THE ONLY WAY TO REGISTER
YOUR CLUB - NO PHONE CALLS PLEASE.
Please mail or fax to: John Burdette
P.O. Box 418
Buckhannon, WV 26201
Fax 304-472-3601

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