Pennsylvania Striped Bass Association
Membership Application
P.O. Box 502 James Creek Pa. 16657
Name___________________________ Date_________ Phone (______)_________________
Spouse_________________________________ Number of family members age 18 and under_____________
Mailing address________________________ City________________________ State________ Zip___________
Email address____________________________________________
Raystown Lake Region___________________
Other Lakes in Pa.____________________
Yearly Family Membership fee for 2007 is $25.00.
Business Membership with business card ad in newsletter $50.00._______
Memberships paid after Sept.1st will be applied to the next year.
Memberships are good until Dec. 31st of 2007
Donations for contributing to the Striper Fishery in Pa. Lakes each $5.00 donation will buy approximately 15 to 20,
2 inch Stripers for stocking in your
YOUR REGIONAL LAKE
$5.00_______$10.00________$15.00_________$20.00_________$25.00________
Total submitted____________
Thank You For Your Support
Web site www.fishpsba.com