Name: _____________________________________________________________________________

Address: ___________________________________________________________________________

City: _______________________________________ State: __________  Zip: ___________________

Phone:      ______________________________________________________________________
Gallatin Co Bass Club
Application for Membership
$20.00 GCBC Annual Dues
$10.00  Kentucky BASS Federation dues. ( All GCBC members                     are required to join the State Federation).
$15.00 BASS National Chapter dues. Each member is required to                    keep an updated BASS membership on his own. This must be up to        _________ date to be qualified to participate in Club functions. 
$45.00  Total Dues per year

Dues
BASS membership # ___________________________________________
(New members are required to submit upon receipt to Club Secretary/Treasurer)
Nominating Members Statement
I personally know the above applicant and endorse his membership .______________________________________________________________
If accepted as a member of the Gallatin Co Bass Club. I agree to abide by all rules of the Club and to participate in club functions including work days as well as fishing events.

Signature__________________________________________________
This application is for introduction of prospective member only.  Membership determination will be by secret ballot after presentation of application at regular Monthly Meeting. New member is not required to be in attendance upon presentation of application.
Club action taken:  
Date: ______________________    Vote:   Yes _____________  No ______________

Date Entered on Roll: ____________________ Sec/Treas. _____________________________
For Club Secretary use only!
revised April 29, 2004