HPSM entry form

CITY:___________________________________________________

STATE:________

ZIP:____________

PHONE NO. : ( ) _____________________ EMAIL ADDRESS:____________________________________

JUNIORS/SENIORS: Date of Birth:

Month________

Day______

Year_______

ASR&PA MEMBERSHIP NO._______________________________

Exp. Date_________________(Send copy)

CLASSIFICATION (CIRCLE ONE)

HIGHPOWER RIFLE	MASTER	AAA	AA	A	B
HIGHPOWER HUNTER RIFLE	MASTER	AAA	AA	A	B

SPECIAL AWARDS (CIRCLE ONE IF APPLICABLE)

SENIOR (60-69 YEARS)

SUPER SENIOR (70 YEARS & UP)

WOMAN (NON-JR., NON SENIOR 21 -59 YRS.)

JUNIOR (18-20 YRS)

INTERMEDIATE JUNIOR (15-17 YRS)

SUB JUNIOR (14 YRS. & YOUNGER)

MATCH FEES (DEADLINE March 27 FOR DISCOUNTS)

FIRST RIFLE……...………………………………………...........................……	$85.00 ______________
SECOND RIFLE………………………………………...........................………..	$25.00 ______________
JUNIORS, INTERMEDIATE, SUB-JUNIORS….....................……………...	$35.00 ______________
SECOND RIFLE (JUNIORS)……….........................…………………………..	$20.00 ______________
EARLY ENTRY DISCOUNT…….............................…………………………	(-$10.00) ____________
ASR&PA DISCOUNT…………….............................………………………….	(-$5.00) _____________

You must send a copy of your ASR&PA card to get this discount.

Please mark for the dinner.

Do you plan to attend the dinner after the match? Yes____No____

If yes, will you have guests and how many? ($15.00 ea x _____)

______________

TOTAL AMOUNT SUBMITTED…………………………………..……..______________

SQUAD ME WITH:______________________________________________________

MAIL ENTRIES TO:

Jim Hebenstreit

7865 W. Redfield Rd

Peoria, AZ 85381

Make checks payable to: Hassayampa Rod & Gun Club

Include copies of your NRA card, ASR&PA card, and the appropriate page(s) of your classification book