Your Name: 

Name of your Guide Service or Charter:

Guide Phone & Alternate:

Guide e-mail address:

Check Here if no change to address:

      Mailing Address/City/State/Zip:

      Physical Address (if different than above):

Your business will be featured on the CBGA web site.  Please supply the following information:

Website URL: (Note: Only one web link per membership.)

Current Vessel/Boat Name &/or Make:

Current Registration #:  

Check the Box(s) that Apply to your Guide/Charter Service:

Have you updated your license in the last year? Yes No
If yes, please make arrangements to bring your license in for updating our records.

Have you purchased a new boat or received new TX numbers in the last year?  Yes No

If yes, please make arrangements to update your information for our records.

Do you need new CBGA stickers?  Yes No

Do you need a new CBGA hat?  Yes No

Do you want to order a CBGA long sleeve fishing shirt for use at CBGA events? Yes No

Sizes Available are:    Small Medium Large X-Large XX-Large XXX-Large

If yes, shirts are free if you commit to two CBGA events or pay $ 44 each, plus $5 more for 2X & 3X - Order below.)

Check the boxes that apply:  I can fish these events:

South Texas Children’s Home    Yes No  

Chemo Kids Yes No

Or bill me for the shirt Yes No
 

Electronic Signature:
Read the following statement carefully, then acknowledge that you have read and approved it by providing the information requested at the bottom of the page.  Please note that an e-signature is the electronic equivalent of a hand-written signature.

I declare that the information that I have provided is accurate and up-to-date.  By my e-signature below, I certify that I have read, fully understand and accept all terms of the foregoing statement.
 

Applicant's Electronic Signature:      Date of Application:

(Please type your name as it appear on your Texas Drivers License.)

FOR YOUR SECURITY PLEASE TYPE IN THE LETTERS SHOWN:      

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