Hank Smith Memorial Entry Form
Please Mail to:
Birds Landing Sporting Clays
2099 Collinsville Rd Birds Landing, CA 94512
or Fax to (707) 374-2814
Name:
Mailing Address:
City:
State:
California
Arizona
Colorado
Montana
Nevada
New Mexico
Oregon
Utah
Washington
Zip:
E-Mail:
Home Phone:
Daytime Phone:
NSCA Member? (
Yes /
No )
NSCA #:
NSCA Class:
Choose One
Master
AA
A
B
C
D
E
NSCA Concurrent 1:
Choose One
Sub Junior
Junior
Lady
Veteran
Super Vet
NSCA Concurrent 2:
Choose One
Sub Junior
Junior
Lady
Veteran
Super Vet
Flight Request (Check One): Pre-Flight
Main Flight (AM)
To guarantee squad, please mail forms in same envelope.
Pre-flight maximum squad size: 4 shooters Main flight maximum squad size: 6 shooters
Main Event ($79): $
12 Gauge Event ($40): $
16 Gauge Event ($40): $
20 Gauge Event ($40): $
28 Gauge Event ($40): $
.410 Event ($40): $
Side by Side Event ($40): $
Pump Gun Event ($40): $
Total: $
Payment Method:
Cash:
Check:
Visa / MC #
Exp:
Signature:_________________________________
3 Digit Security Code:
Fill out form, print, then mail or fax to Birds Landing Sporting Clays for processing.