IEBC Bass Fishing Membership Fee Form and Information - 2008

One of the things we try to do for our club members is to give them as many opportunities to fish as possible. For that reason we are now offering our members a one stop shop for a variety of membership fee payments in a number of organizations. By filling out this form and writing one check you can join the Inland Empire Bass Club, BASS (State, National, General) and FLW (State, National, General TBF). We even have a spot were juniors can pay their dues. Remember, you must be a paid member in the IEBC to sign up with the other organizations.

This year’s schedule was designed to accommodate those of you who wish to fish the club as well as BASS State Qualifiers and FLW State Qualifiers. A brief description of each organization is included on another document. To mail your dues send to:

Joel Nania, 1927 S. Liberty Drive, Liberty Lake, WA 99019

Check it out, fill in the blanks, write one check to the IEBC and go fish!!!

Organization Dues Check if Yes Enter Amount

Inland Empire Bass Club – Family $35 __________ ___________

Covers Spouse and children under 18

BASS - Individual

Adults- all 3 required to fish state qualifiers

State Federation Nation $15 __________ ___________

National Federation Nation $20 __________ ___________

BASS subscription $25 __________ ___________

Juniors – both required to fish state championship

State Federation Nation $5 __________ ___________

BASS Subscription $15 __________ ___________

FLW - Individual

Adults- all 3 required to fish state qualifiers

State Federation $15 __________ ___________

TBF National $20 __________ ___________

FLW Outdoors subscription $25 __________ ___________

Juniors – both required to fish state championship

State FLW $5 __________ ___________

FLW Subscription $15 __________ ___________

Make check payable to the IEBC- Total Check to Write $ ___________(total)

IMPORTANT: Turn over for required information and signature.

(Continued)

(Page 2 of 2)

Required Information

Name: __________________________ Phone Number: __________________

Address: ________________________ Bass ID Number: _________________

City and Zip: _____________________ FLW ID Number: _________________

Spouses Name: ____________________

Children’s names and ages under 18 years old: Division if Fishing (circle one)

1) _______________________ Youth – General – Women

2) _______________________ Youth – General – Women

3) _______________________ Youth – General – Women

4) _______________________ Youth – General – Women

5) _______________________ Youth – General – Women

E-mail address: _________________________(needed for FLW and BASS)

Division in which you will fish (circle one): General – Women – Youth

Division in which your spouse will fish (circle one): General – Women – Youth

Provisions of Memberships and Release of Liability

(must be signed by applicant, if under 18 must be signed by parent or guardian)

The Inland Empire Bass Club is a non-profit organization located in Spokane, Washington. The club reserves the right to refuse membership or tournament participation without cause to anyone.

Liability: By signing this form club members, spouses, children and guests assume a risk as related to the events held by the Club including but not limited to those activities that involve the risk of serious personal injury, illness, permanent disability, dismemberment and death and that also involve the risk of severe economic and property loss and damage. Signators understand that these risks may result from the actions, negligence, fault, omission and failure to act of themselves and others, sponsors, organizers, club officers and volunteers of Club activities and from the rules of play, the challenges of the events and the condition of any property, facilities or equipment used. Members, spouses, children and guests also understand that there may be risks involved which are not known to them or to the distributors, sponsors, organizers and other volunteers, may not be foreseen or reasonably foreseeable by any of them or us at this time or at the time of any Club activity. By signing this form members, spouses, children and guests of members agree to assume all risks and accept personal responsibility for any injury or damages that may occur as a result of participation in any club activity which includes tournaments, meetings, picnics, parties and other activities not listed here and hereby release, hold harmless and forever discharge, the Inland Empire Bass Club, all sponsors, volunteers, tournament officials and club officers from any and all liability.

By signing this form you and your family members and/or guests agree to be bound by and comply with all rules and regulations as outlined in Club bylaws and other requirements as listed in club information. Your signature is also confirmation that you maintain and will have updated for 2008 season a minimum of $100,000 in boater’s liability insurance as indicated in the club rules and by-laws.

Signature: _______________________ Date: __________________

Print Name: _______________________ (form date: 1/11/08)

Additional forms may be copied or printed off of the Club website: www.inlandempirebassclub.com.