Membership Application
Chautauqua Lake Bassmasters

PO Box 575
Celoron, New York 14720

Type of Application:  New:  _____ $25.00         Renewal:        _____ $25.00

Applications are accepted only during regular monthly meetings (first Sunday of every month).  The application may be brought to the regular meeting or mailed with the application fee to the address above.  Make checks payable to:  Chautauqua Lake Bassmasters. 
$$$ Money Must Accompany Application $$$




State: Zip:
Email Phone:
Cell Phone:
Boat Owner?

Yes No

Make of Boat:
Motor: H.P.:

Are you a minimum of 16 years old?  Yes No    

*****For New Membership Only****

Reason For Joining:
Sponsor's Name:

By my signature below, I declare that, if accepted for membership in the Chautauqua Lake Bassmasters, I will support and abide by the club's by-laws, rules and regulations. I also declare that I will always conduct myself in a manner as not to bring disgrace or dishonor upon the Chautauqua Lake Bassmasters and it's members. I understand that failure to do so may result in termination of my membership and all it's benefits, without recourse.

Applicant’s Signature:__________________________________ Date: _____________

   ****Official Use Only****
Date Applicant Voted In: _______________ Date Dues Received: ______________

****Meetings are held the 1st Sunday of Every Month****
6pm at Friendly’s Restaurant Main St Jamestown, NY 
Contact Number 716-665-1562