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Wallum Lake Rod and Gun Club

“WALLS OF STEEL”

Thursday, Friday, Saturday, Sunday

August 19, 20, 21, 22 2010

ENTRY FORM

Name (please print) ____________________________________________________________________

Address _____________________________________________________________________________

City/ State/ Zip Code ___________________________________________________________________

Phone _________________________________ E-Mail Address ________________________________

CHECK THE DIVISIONS YOU WILL BE SHOOTING UNDER THE CORRESPONDING DATE/TIME

Thursday-August19—2 pm_ FULL Stock Auto FULL Open Auto FULLStock Revolver FULL Open Revolver

Friday- August 20—9 am _______ Stock Auto _____ Open Auto _____ Stock Revolver _____ Open Revolver

Friday- August 20—2 pm___ _____ Stock Auto _____ Open Auto _____ Stock Revolver _____ Open Revolver

Saturday-August 21—9 am_ _____ Stock Auto _____ Open Auto _____ Stock Revolver _____ Open Revolver

Saturday- August 21—2 pm_ _____ Stock Auto _____ Open Auto _____ Stock Revolver _____ Open Revolver

Sunday-August 22—9 am___ _____ Stock Auto _____ Open Auto _____ Stock Revolver _____ Open Revolver

Check all that apply: _____ Lady _____ Sr. (60 +) _____ Jr. (16 & under)

Entry Fees: 1 gun @ $50.00

2 guns @ $85.00

3 guns @ $100.00

4 guns @ $110.00

1 Free T- Shirt if you register before July 19th --- Circle size: S M L XL 2X 3X 4X

Additional shirts @ $12.00 ______

Total Amount Enclosed $_________

Please make checks payable to: Wallum Lake Rod & Gun Club

Mail to: Jim Richardson

342 Logee Street

Woonsocket, RI 02895

Phone: (401) 480-9641 or E-Mail: jimbo641@msn.com

www.wallumlakerodgun.com