Annual West Tennessee
Industrial & Commercial Bass Tournament

September 28, 2014
Birdsong Resort, Marina & Campground


(Information submitted on this form IS SECURE using the latest encryption technology)

Personal / Individual Registration

NOTE: All participating companies must verify that team members are in fact their employees!

Companies, please click here to register your team(s).

Who do you work for? (that's putting a team together to fish in this tournament!)
Company Name:



Partner's Name (for reference):
Address:
City/State/Zip:
Your Supervisor's Name:

(If unsure the exact name to use, check with your manager or supervisor to verify the name under which your company registered.  If you submit something in error, email us with a correction.)
Who are You?
First Name: Last Name:
Address: (your home address, please)
City/State/Zip:
Home Phone: Work Phone:
Your Email: Social Security Number:
  
Do you want to personally enter the Big Bass Jackpot? 
The entry fee is $20.00 per person and is not paid by your employer.  If you would like to participate, please complete the following billing information. We'll send email to the address above containing verification and proof of the transaction.
Credit Card # Expires:(mm/yy)
Exact Name Card:

 

Your card will be billed $20.00 within a couple of days.
***
If you would prefer to mail your registration, print, complete and mail this form along with your check made payable to:
Birdsong Resort, Marina and Lakeside RV Campground
255 Marina Road
Camden, TN 38320-9699
ATTN: Industrial Bass Tournament Registration
Our fax number is: (731) 584-3625
Any comments regarding this registration?  Feel free to type 'em below:

LETS GO FISHING!



(click only once...it may take a moment to process!)

By sending this application, we hereby waive and release all other contestants, hosts, sponsors, and tournament officials from all claims of injury and/or material and bodily damage incurred in connection with this tournament.