2018 entry form - nra bianchi cup...
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2018 ENTRY FORM - NRA BIANCHI CUP CHAMPIONSHIP
•REGISTRATION INFORMATION1. Complete all sections of the Entry Form.2. Fax or mail this form with payment to:
Fax: NRA Action Pistol(703) 267-3941
Mail: NRA Attn: Bianchi Cup Coordinator11250 Waples Mill RoadFairfax, VA 22030
NRA Membership Number OR Non-MemberCompetitorClassificationNumber
Last Name: First Name & Middle Initial:Female Male Team Name:
Home Street Address:City, State, ZIP:Primary Phone Number: SecondaryPhoneNumber:E-Mail Address:
CURRENT NRA ACTION PISTOL CLASSIFICATIONHigh Master Master Expert Sharpshooter Marksman Unclassified
CHAMPIONSHIP DIVISION-Checkonlyone-
OPEN METALLIC PRODUCTION
SPECIAL CATEGORIES POLICE SERVICE INTERNATIONAL 1ST TIME REVOLVER
SENIOR GRAND SENIOR JUNIOR WOMEN
PAYMENT INFORMATIONI am paying by Credit Card - Card must be in your name with billing addressmatchingtheaddresslistedonregistration.
Chargeto: Visa DiscoverMastercard AmericanExpress
Number:_______/_______/_______/_______Exp.Date:____/____
Signature: _______________________________________________
IampayingbyCheckorMoneyorderpayabletoNRA.
MEDIA INFORMATION & RELEASE1. IgranttheNationalRifleAssociationofAmerica(NRA),of11250WaplesMillRoad,Fair-fax, Virginia 22030, the right to use, publish, and reproduce, at any time, any and allphotographsorvideorecordingsofmeduringthe2018NRABianchiCupActionPistolChampionship events in which is depicted my image, likeness, and/or name for anyeditorialuse,promotion,advertising,orotherpurposeswhatsoever.IreleaseNRA,theNRA Bianchi Cup Coordinator, The Green Valley Rifle & Pistol Club, their directors,agents,officers,employeesandservantsfromanyandallclaimsfordamagesforlibel,slander, invasion of privacy, or any other liability which may arise out of any loss,damage, injuries, or death which I may sustain, and any theft, unexplaineddisappearance or damage, of which may befall any of my property or propertyaccompanyingmewhileenrouteto,duringparticipationofthetournament,andenroutefromthe tournament,orwhileon thepremiseswhereanyof the tournament events or social activity occurs, or any other claim. 2. I am over the age of twenty-one(21), have previously participated in competitive shootingmatchesand/oramawareof the risksandhazardsofsuchevents including,butnotlimitedto,accidentaldischargeoffirearms,injury anddeath,andlossofpersonalproperty through misplacement or theft. I voluntarily assume all risks.
3. I agree to complywithall the rules, regulationsanddirectionsof theTournament.
4. Iassumeallresponsibilityformyguests,andIfurtheragreetoindemnifyandsaveharmless theTournament foranyactsofmyselformyguest to fail tocomplywithallrules, regulations and direction of the tournament. The Tournament has the right toterminatemy participation immediately. I further state that I have read the foregoingAgreementandReleaseandfreelyenterintoitonbehalfofmyselfandmydistributes,heirs,nextofkin,executors,andadministrators.
Signature:______________________________________ Date:_______________________
ENTRY INFORMATION FEES ALLENTRIESBYJANUARY31
ALLENTRIESBYFEBRUARY28
ALLENTRIESMARCH1-APRIL30
ALLENTRIESAFTERMAY1
ACTIVEDUTYMILITARYBYMAY12
$300.00
$350.00
$400.00
$450.00
$275.00
$175.00
$75.00
MULTI-GUN AGGREGATE ENTRYCIRCLE ONE -OPEN / METALLIC / PRODUCTION
JUNIORENTRY
GUESTS
TOTAL:
NEWCOMPETITORENTRY $275.00
MEAL SELECTION
GUESTMEALSELECTION BEEF CHICKEN VEG
BEEF CHICKEN VEG
$125.00