REGISTRATION FORM

2022 Indiana State Junior High Power Championship

July 16, 2022 at the Fort Wayne Rifle and Revolver Club

15715 Rupert Road; Harlan, IN

(See the Match Program for details)

Name: ________________________________  Age (As of 31 Dec 2022):  _______

Address:________________________________

 City: ____________________        State: IN           ZIP: __________

Club Affiliation: __________________  NRA Classification_____________________

Email:  __________________________

For Junior Participants; Lunch is free. I want a free lunch:  ___ YES          ___NO

Additional lunches for parents, sponsors and spectators @ $10.00/each;   # ______

For Junior Participants; an event T-shirt is free.    Size (S, M, L, XL, XXL)  _________

Additional T-shirts for parents, sponsors and spectators @ $11.00/each:

Small _____   Medium _____   Large _____   X-Large _____   XX-Large _____

For additional information, contact Larry Beardsley at FWRRHPDirector@aol.com