Wallum Lake Rod and Gun Club

“WALLS OF STEEL”

Thursday, Friday, Saturday, Sunday

August 20, 21, 22, 23, 2009

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-August 20--9 am Friday- August 21—9 am Saturday-August 22—9 am Sunday-August 23—9 am

Reserved _____ Stock Auto _____ Stock Auto _____ Stock Auto

_____ Open Auto _____ Open Auto _____ Open Auto

_____ Stock Revolver _____ Stock Revolver _____ Stock Revolver

_____ Open Revolver _____ Open Revolver _____ Open Revolver

Thursday-August 20—2 pm Friday- August 21—2 pm Saturday- August 22—2 pm Sunday- August 23—2 pm

_____ Stock Auto _____ Stock Auto _____ Stock Auto Reserved

_____ Open Auto _____ Open Auto _____ Open Auto

_____ Stock Revolver _____ Stock Revolver _____ Stock Revolver

_____ Open Revolver _____ Open Revolver _____ Open Revolver

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

Entry Fees: 1 gun @ $50.00 Check all that apply:

2 guns @ $85.00 _____ Lady

3 guns @ $100.00 _____ Sr. (60 +)

4 guns @ $110.00 _____ Jr. (16 & under)

Additional shirts @ $12.00 ______ Size _____

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

Checks and entry forms must be received no later than July 19th, 2009— www.wallumlakerodgun.com