Sporting Clay Registration Form

July 31—August 1, 2004

Millwood Lodge

Please complete and mail to:

PO Box 4094

Dublin, GA 31040

Or Fax to:

(478) 272-2793

Name:  _______________________________________________ (one form per person please)

Address:  ____________________________________________________________________

City:  __________________                State:  _____________                         Zip:  ____________

Daytime Phone:  ________________________         Email:  ____________________________

——————————————————————————————————————

Please charge my: ____Visa____Mastercard____American Express____Cash____Check#____

Card # __________-__________-__________-__________               Exp. Date ______________

 

Signature  _____________________________________

Cardholder BILLING Street:  _______________________________________ Zip:_________

(This is where your credit card bill is mailed) - If numbers are not provided, credit card company will decline your card.

 

 

Date

Received

 

__________

 

Sporting Clays Main Event

European Rotation

Lewis Class Event

3 Classes—5 Places Deep

$135.00

 

 

Golf carts available by reservation only.

$50.00 per day

Reserve by July 20, 2004

Early Bird Registration:

All entries received by July 20, 2004 will be eligible to win a Ruger 77 Rifle

(Retail $550.00)

Sporting Clay Total:  _________

Golf Cart Total:  _____________

Overall Total:  ______________

Amount Received:  ___________

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