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Pentwater Sportfishing Association Membership Application / Renewal Form

Date: __________________

Name: _________________________________________________

Name Spouse (if applicable) ________________________________

Mailing Address: _____________________________________________________

City: ____________________________________

State: __________ Zip Code: __________

Phone Number: __________________________

___________________________

Check here to receive your newsletter via e-mail: _________

E-mail address: ___________________________________________________________

Boat Name: ________________________________________________

Membership: (please circle one) Self - $10.00 Self / Spouse $15.00

Added Support Funding:

Channel Lights $_________________

Fish Cleaning Station $___________

Teach A Kid Event $______________

I would like to help with the following Association sponsored events:

Memorial Derby: _____

Mini-tournament weigh-ins: _____

Teach A Kid Event: _____

Ladies' Tournament: _____

Channel Light Maintenance: _____

Serve on Board of Directors: _____

Mail Form with Payment To: PSA, PO Box 173, Pentwater, MI 49449