DATE:________________

NAME:______________________________________________

ADDRESS:___________________________________________

CITY & STATE:_______________________________________

ZIP CODE:____________________

TELEPHONE:__DAY_____________EVENING_______________

T.B.F. MEMBERSHIP#:_______________________________
T.B.F. EXP. DATE:___________
BOATER:_____________________NON-BOATER____________

SIGNATURE:_________________________________________

RETURN TO:  JOHN DELL, SECRETARY
                Trailer Hook Bass Anglers
                42 BRAINTREE COMMON.
                UPPER HOLLAND PA 19053 ( 215 891-8185)
CHECKS, payable to: TRAILER HOOK BASS ANGLERS
FEES:  $ 35.00 T.B.F. FEDERATION
        $ 15.00 PA. FEDERATION