<p> GEORGIA B.A.S.S. NATION </p><p>2016-2017</p><p>REGISTRATION FORM FOR YOUR TEAM</p><p>NAME OF ANGLER: </p><p>ADDRESS </p><p>CITY STATE: (GA) ZIP: </p><p>PARENT or GUARDIAN: </p><p>PHONE NUMBER 1: Number 2: PLEASE PROVIDE 2 CONTACT NUMBER</p><p>PARENT EMAIL: </p><p>BIRTHDATE OF ANGLER: </p><p>SCHOOL:</p><p>Coach/Sponsor at school name & email address:</p><p>Contact: Michelle L. Volk</p><p>Georgia BASS Nation High School Youth Director</p><p>85 Shepherd Drive, Lithia Springs, GA 30122</p><p>770-206-0120</p><p> [email protected] </p><p>Dues for GA BASS Nation High School fishing are $10.00 per angler Tournament Registration Form</p><p>LAKE: </p><p>SCHOOL: ______</p><p>ANGLER 1: ______***ALL ANGLERS ARE REQUIRED PH#: ______TO SHOW PROOF OF BOATER SAFETY COURSE AT CHECK IN FOR ANGLER 2:______EACH EVENT***</p><p>PH#:______</p><p>(Student anglers must attend same school and provide proof)</p><p>Boat Captain: ______</p><p>PH#: ______</p><p>Boat: ______</p><p>Motor: ______</p><p>Color: ______</p><p>***Waivers MUST accompany tournament registration, 1 waiver per angler per lake***</p><p>Event fee: 50.00/boat (registered 3 days prior to event) checks payable to GABNHS</p><p>60.00/boat (if registered 3 days leading to event Weds, Thurs Friday)</p><p>*****If you choose to pay on DAY OF EVENT there will be a $25.00 PENALTY*****</p><p>Mail entry form and waivers:</p><p>Michelle Volk</p><p>85 Shepherd Drive</p><p>Lithia Springs, GA 30122</p>