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Larry Larsen

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Peacock Bass Log

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Peacock  Bass  Association
www.peacockbassassociation.com
 Executive Director: Larry Larsen

Membership Form - Individuals

YES, I want to join the PBA!

Membership valid for one year to the nearest calendar quarter.   If paying by check, print the completed form and mail to the address below. If paying by credit card, you may click the submit button below.

  1-year Standard Membership  $34.95 - Special Summer Offer for New Standard Memberships with U.S. address! Join Now and receive our Standard Member Benefits PLUS a "Peacock Bass Addiction" book FREE! ($20 value). Please use promotional code "SUMMEM" below. Offer valid thru 8/31/10.
($39.95 if B&W newsletter by mail to U.S. address) includes decal and patch

  ($39.95 if B&W newsletter by mail to U.S. address) includes decal and patch. (Renewal dues $34.95)

  1-year Premium Membership $49.95
includes decal and patch plus your choice of one of the following items - DVD, T Shirt,  book or cap

  3-Year Basic Membership $84.99 includes decal and patch only - no premiums.

  3-Year Standard Membership $99.95
includes decal and patch plus your choice of one of the following items - DVD, T Shirt,  book or cap

  3-Year Executive Individual Membership  $129.95
includes $250 Trip Discount Certificate with selected agents/outfitters  - Click Here For Details

    Renewal or 3-yr. Extension - Current Members check here.

Add your Membership # OR Promotional Code (if available) 

First Name       Last Name
Company

Address (as it appears on your credit card statement)

City State Zip

Phone Fax

email address (Important)  You will receive full color newsletter via e mail.
 

   I don't have an e mail address. I will pay $39.95 for standard membership to receive the B&W newsletter by U.S. mail
 

  Once my membership is acknowledged, I will call for my free 10-minute consultation with Larry Larsen.

If you have selected 1 Year Premium or the 3-Year Standard Membership, select one of the following below:

DVD -     or    

Book     PF3  OR   PF4    or

Peacock Bass Cap      or

T Shirt -   TS1 Explosions!  OR     TS2 Addiction
         Indicate Size         M          L         XL   or     XXL

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Credit Card Billing Information
                    Visa      MasterCard      American Express
Number    Exp date

Name as it appears on your credit card


Signature_____________________________________________
Submitting this form authorizes PBA to charge my card for my membership fee above. If you prefer, you may submit this completed form and provide your credit card information by phone.

Home                                             Contact Us                                    Mission & Privacy Policy

All rights reserved © 2001-2010 Larry Larsen.  No part of this website may be reproduced or transmitted in any form or by any means without permission in writing from the association. Factual information, names, addresses and telephone numbers are subject to change and often do. We have tried to bring you the most updated information available. The Peacock Bass Association is not liable for problems associated with the reliability of information provided on our website or printed materials.

Peacock Bass Association (PBA)
2640 Elizabeth Place, Lakeland FL 33812
 (863)644-3381
We accept credit cards    Website design by Lilliam M. Larsen