ARIZONA BENCHREST SHOOTERS

NBRSA Nationals Registration Form – October 6^th – 11^th 2003

I do hereby release the Ben Avery Shooting Facility, Arizona Benchrest Shooters Club and the National Benchrest Shooters Association Inc., along with their officers and officials from any and all claims for liability and damage that may be sustained by me by virtue of my participation in this match, conducted by said club and registered by the National Benchrest Shooters Association Inc.

Signed_________________________________ Date__________ Printed Name______________________________

Address________________________________________________________________________________________

City_________________________________________State____________________Zipcode____________________

Email Address___________________________________ Phone number____________________________________

ARE YOU A MEMBER IN GOOD STANDING OF THE NBRSA YES_____________ NO_____________

If no, you must join NBRSA now to shoot this match.

UNL LV SP HV

CART/Cal ________________ ________________ ________________ _______________

ACTION ________________ ________________ ________________ _______________

BARREL ________________ ________________ ________________ _______________

STOCK ________________ ________________ ________________ _______________

STOCKER ________________ ________________ ________________ _______________

GUNSMITH ________________ ________________ ________________ _______________

SCOPE ________________ ________________ ________________ _______________

BULLET ________________ ________________ ________________ _______________

POWDER/WT________________ ________________ ________________ _______________

PRIMER ________________ ________________ ________________ _______________

Match Fee 4 gun participation $190 NBRSA Match participation $30/day + mandatory $10 Trophy fee

----3Gun $ 130, includes the $10 Trophy fee

Nationals is a pre-registration tournament; Registrations received (post office stamp) after September 6^th will incur a $10 late fee.

Arizona Benchrest Shooters incur a $5/day fee per shooter from Ben Avery Facility. Shooters wishing to help offset that cost with a donation can do so. Please make a check out to Ben Avery Shooting Facility and forward to Arizona Benchrest Shooters.

If you are shooting less than the 4 gun, call for match fee’s. If shooter’s are requesting a specific bench rotation (sharing flags, rests, etc) request this on the backside of this form)