New Online Membership Form

WESTERN PA TEAM BASS SERIES ANNUAL MEMBERSHIP FORM AND B.A.S.S. TEAM MEMBERSHIP FORM

When an angler chooses to become a member of the Western PA Team Bass Series he/she will be afforded the opportunity to register and compete in any of the five regular season events held by the Western PA Team Bass Series. As a member, you also are given the chance to qualify for any special event not part of the five regular season events such as the B.A.S.S. Team Championship event or the end of season championship event. (must be 16 years old or older to compete in the B.A.S.S. Team Championship at the time of the championship)

The annual membership fee per member is $50. Of that $50, $10 will go to a B.A.S.S. Team Championship membership and a one year subscription to B.A.S.S. Times. This affords each member an opportunity to qualify to fish in the B.A.S.S. Team Championship event with the winner of said event being allowed to fish in the following year's Bassmaster Classic. The remaining $40 of the membership is used to run a portion of the operating costs for the organization. (a Social Security number is needed for membership)

First Name

Last Name

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

DATE OF BIRTH (IF UNDER 18 MUST FILL OUT THE MINOR RELEASE FORM AND SUBMIT)

SSN#

PLEASE CHECK BOX IF POTENTIAL MEMBER IS A MINOR

Phone

Team Members Name

*By signing the below entry form, I hereby release Western PA Team Bass Series and all its officers, agents, employees, and sponsors from any and all damages, claims, costs or expenses relating to injury or even death, of any person or property, which we may sustain or cause by reason of our participation in or in connection with any tournament or event. I further authorize the use of any images or likeness of our person and name(s). I also have read and understand all the rules and regulations governing Western PA Team Bass Series and its events. WPTBS is not responsible for any local, state, or federal taxes being withheld from any winnings or payouts.

*(i) "I hereby waive my rights of privacy or publicity with regard to the programs of the tournament in which I appear and consent to B.A.S.S., LLC's (and its parent, affiliated and subsidiary companies, and those acting under their permission or upon their authority), copyrighting, distributing, televising, publishing and using in any way the audio and visual portions of any television videotape, film and photographs pictures of me or of interviews, scenes or other sequences in which I may be included, and any reproduction thereof, anywhere at any time through any medium or media for advertising, promotion, trade, television programming or other lawful purpose whatsoever; and I shall not be entitled to receive any royalties or other compensation in connection with such use."

*(ii) "I acknowledge and agree that B.A.S.S., LLC (and its parent, affiliated and subsidiary companies, and those acting under their permission or upon their authority) shall have the right to use my personal information to contact me with communications and other advertisements, and may provide such information to any sponsor of B.A.S.S., LLC or its parent, affiliated and subsidiary companies, which sponsor may contact me with communications and other advertisements."

*(By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By typing your name, you consent to be legally bound by this Agreement’s terms and conditions. You further agree that your use of a key pad, mouse, or other device to type your name. You also agree that no certification authority of other third-party verification is necessary to validate your E-Signature and that the lack of such certifications or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and WPTBS. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement)

Your Signature

Select a date

(THERE WILL BE A $2 FEE ADDED TO THE TOTAL TO COVER THE ONLINE FEES. TO AVOID THE $2 FEE SEND APPLICATIONS AND PAYMENT BY MAIL.)

I agree to allow WPTBS to release my name and e-mail address to its sponsors in order to receive promotional communications from them.

Thanks for registering!