Electronic Entry Form
ARIZONA STATE PISTOL CHAMPIONSHIPS
Date of Tournament: October 20 & 21, 2007
Last Name First Name MI
Address City State ZIP +4
Contact Phone: E-Mail:
High-Master Master Expert Sharpshooter Marksman Unclassified
NRA # Junior Senior Woman
Military : Active Duty Reserves Retired
Army Navy USMC USAF ANG USCG
Law Enforcement Arizona State resident Not an Arizona State resident
I will be attending the Saturday's BBQ . Guest? How Many Cost is $7 per person.
CONVENTIONAL MATCH PROGRAM
.22 CALIBER MATCHES $12.00
CENTER FIRE MATCHES $12.00
.45 CALIBER MATCHES $12.00
REGISTRATION FEE (non-refundable) $15.00
DISTINGUISHED REVOLVER MATCH $6.00
CONVENTIONAL PROGRAM PACKAGE (2700) $51.00
TEAM MATCHES
.22 CALIBER TEAM MATCHES $12.00 per team
CENTER FIRE TEAM MATCHES $12.00 per team
.45 CALIBER TEAM MATCHES $12.00 per team
TEAM MATCH PACKAGE $36.00 per team
NBPRP “LEG” MATCH $12.00 per individual.
WAVER & RELEASE FROM LIABILITY
1. I understand and am aware of all the risk and/or hazards related to participating in any activity coordinated and/or conduced by and at the Phoenix Rod & Gun Club, 915 West Olney, Dr., Phoenix, AZ 85041.
2. In participating in any activity coordinated by and/or conducted at the Phoenix Rod & Gun Club, I do so voluntarily, without coercion and/or direst, and in my own individual capacity.
3. As with any activity coordinated by and/or conducted at the Phoenix Rod & Gun Club in which I participate, I understand and/or agree that I will be responsible for any and all of my own actions, and/or my guest.
4. I hereby expressly assume any and all risks of loss, damage, and/or injury to my property, and/or person, including death, that I may sustain by reason of and/or in connection with participating in any activity coordinated by and/or conducted at the Phoenix Rod & Gun Club.
I HEREBY REPRESENT AND/OR ACKNOWLEDGE THAT I HAVE READ THIS WAIVER AND RELEASE FROM LIABILITY, FULLY UNDERSTANDING EACH AND EVERY PROVISION OF THIS WAVER/RELEASE AND ON THIS DATE, DO VOLUNTARILY EXECUTED THE SAME. I FURTHER REPRESENT AND/OR WARRANT THAT I AM OF SOUND MIND, AND I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND HAVE THE LEGAL CAPACITY TO EXECUTE THIS AGREEMENT, UNLESS CANCELED BY MYSELF IN WRITING, THIS WAIVER IS TO HAVE FULL EFFECT AT ALL ACTIVITIES AND/OR EVENTS DURING THE CLUB'S CALENDAR YEAR.
Signature:___________________________________ Date: ____________________
Print out this form, sign liability waver, enclose check or money order and mail to:
Don Plante
Arizona State Pistol Championships
1014 E. Constitution Dr.
Gilbert, AZ 85296