Address-Information Update Form

MEMBERSHIP AND ADDRESS UPDATE FORM (For Updating Adult and Youth Members) NOTE: This form is to be used to update an existing members information only, if this person is a new club member CLICK HERE
* Indicates required Information

Member Name	B.A.S.S. Number (9 digit)	Check One
* Club Name*	Required*	Adult Club Youth Club

Reason for Update:*
Change of Address Information for an Existing Member	Youth Member now in our Adult Club
Change in Club Office/Position	Remove Member from our Club Roster

PREVIOUS INFORMATION (Please fill in as much as possible)
Address	City	State	Zip Code

Email Address	Phone Number Cell Phone

President Secretary Member Youth Member

NEW INFORMATION: (Put the NEW information in the appropriate box)
Address	City	State	Zip Code

Email Address	Phone Number Cell Phone

New Position: President Secretary Member

(a) Submitting this form on the M.B.C.F Website will only ensure the information is updated at the Michigan B.A.S.S. Federation 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)
2. Submit to the B.A.S.S Federation**	3. Submit to the Michigan B.A.S.S. Federation*
A) Mail To: (PRINT the form to submit, when adding a member) B.A.S.S. Federation Federation Membership Department 3500 Bluelake Drive Suite 330 Birmingham, AL 35243	A) Mail To: (PRINT the form to submit) Michigan BASS Federation Nation Membership Director Camille Delikta 24525 Panama Avenue Warren, MI 48091
B) You may submit an update via the Web Site at: B.A.S.S. Member Services	B) You may Submit an information change via the Web Site using this form (at http://www.michiganbass.net)
C) Fax To: (PRINT the form to submit when you are only changing information) 1-205-313-0952 Any questions can be directed to BASS at 1-877-BASS USA	Any questions may be directed to Camille Delikta at MBFN at 586 295-7506 PRINT A BLANK FORM <Click Here

**NOTE: Your Club Membership Person may do this for you, check with them before submitting.

Form Revision Date1-27-12