MICHIGAN B.A.S.S. MEMBERSHIP AND ADDRESS UPDATE FORM
* Indicates required Information

Member Name* Bassmaster Membership No. (9 digit)
Club Name*
Bassmaster Expiration Date:  
Adult Club 
College Club
Junior Bassmaster Club
High School Club
At Large Member
 

Reason for Submission:*    
New Member Information Junior or High School Member now in our Adult Club
Change of Address Information for an Existing Member Remove Member from our Club Roster
Change in Club Office/Position  
(if this is a new member, make sure you mail your Michigan BASS Nation Dues to the Michigan Membership Director shown below, with this form

PREVIOUS INFORMATION (Please fill in as much as possible)
Address City State Zip Code
Email Address Home Phone Number Cell Phone Number
 
President      Member     Junior Bassmaster Club Member   High School Club Member

NEW INFORMATION: (Put the NEW information in the appropriate box)
Address City State Zip Code
Email Address Home Phone Number Cell Phone Number  
 
New Position      
President      Member     Junior Bassmaster Club Member   High School Club Member
(a) Submitting this form to M.B.N. will only ensure the information is updated at the Michigan B.A.S.S. Nation level.    See the information below to submit at the National B.A.S.S. level.
INFORMATION SHOULD BE SENT TO:
1. Submit a copy to your Club's Membership Person (PRINT the form to submit) 3. Submit to the Michigan B.A.S.S. Nation*
Mail To:  (PRINT the form to submit)
Michigan B.A.S.S. Nation
Membership Director Jason Hurst
1700 Teggerdine Road  

White Lake,
 MI 48386

Any questions may be directed to
Jason Hurst at MBN at 248 909-5750 or email at jhurst@michiganbass.net
2. Submit to the B.A.S.S Nation**
Mail To:  (PRINT the form to submit, when adding a member)
          B.A.S.S. Nation
          Membership Department
          3500 Bluelake Drive, Suite 330
          Birmingham, AL 35243
Any questions can be directed to BASS at
1-877-BASS USA