World Peacock Bass Directory
Products & Services Data Form
Submit Electronically (if CC Pd) OR Mail-In with Check only
Credit Card payers - Once you have paid through our Shopping Cart, you still have to fill out this Information Form
and click the "submit Electronically (if cC Paid)" button below to Electronically send us your info.
Check By Mail Payers - If you are paying by check, you must fill out the information, print the form and send it along with your check via USPS mail
to Larry larsen, 2640 elizabeth place, lakeland, fl 33812.
1 year membership - $330.00 (Renewal by check at $300)
2 year membership - $594.00 (Renewal by check at $540)
All Supporting Membership Dues are for the full Calendar year (e.g. 2016, 2017). If you sign up mid
-year, please call for the additional prorated dues cost in order to make your check in the correct amount. There is a one year minimum for PBA Dues.
Name of Company
Contact (for PBA records only)
Product Name or Service
250 words of "promo" copy
We will include up to two color digital images on your directory "promo" page. Please send them in .jpg format attached to a separate email addressed to email@example.com Thank you.
Larry Larsen, 2640 Elizabeth Place, Lakeland FL 33812.
Print this Membership Form - mail with Check (or Money Order) ONLY to:
Any questions, please email me at firstname.lastname@example.org
Supporting Members Logo for Website Use
Supporting Members in good standing may use this logo on their web pages and in
brochures and flyers to show their affiliation with PBA and the principles for which
it stands. Unauthorized use by non-members will not be allowed. Agents, outfitters, industry product manufacturers and service providers joining as
supporting members may download this decal logo.
To copy this logo for use on your website or brochures/flyers, simply right-click
on the logo with your mouse. Then in the window that opens up, click on "Save
Picture As" and then select the drive and file where you want to save it. The digitized logo can then be added to your web page and brochures/flyers.