Elizabeth City Bassmasters Youth Club Registration Form
		The purpose of the Elizabeth City Bassmasters Youth Club is to promote and encourage youth fishing through education of fishing ethics, sportsmanship, techniques and conservation of our natural resources. (Please Print) NAME:_____________________________________________________________ Male____________  Female_____________ ADDRESS: _________________________________________________________                   _________________________________________________________ PHONE NUMBER:  _______________________________________________ DATE OF BIRTH:  Month___________ Day___________Year_________ Elizabeth City Bassmasters will not be responsible for any liability of youth members.  Parent or guardian must supply proof Medical insurance. Parent or Guardian (PrintName)__________________________________________ Address:___________________________________________________________ Parent or Guardian (Signature)___________________________________ Date__________________                              Member #_________________