NORTHPORT ROD & REEL

MEMBERSHIP REWARDS DISCOUNT PROGRAM

PLEASE PRINT AND COMPLETE THIS FORM AND STOP BY THE SHOP TO REGISTER.

NAME: ___________________________________________________

ADDRESS: ________________________________________________

CITY: ___________________________ STATE:____________ ZIP: ________

EMAIL ADDRESS: _______________________________________________________________________________

ARE YOU A BOAT OR SURF FISHERMAN? _________________________________________

WHAT IS YOUR FAVORITE TARGET SPECIES?  ____________________________________

DO YOU FISH NATURAL OR ARTIFICIALS? _________________________________________

TELL US WHAT YOU WANT IN A TACKLE SHOP:____________________________________________________________________________________________________

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