Saturday, January 21st, 2017

Start @ 8:00 AM
Square One Sporting Clays
SR 70, Lake Placid, FL
Registration and Sponsorship Form
All Shooter Levels Include Steak Lunch with all the Fixins.

TEAM SHOOTER LIST

Team Sponsor $400.00 (Includes 4 shooters, and Firing Station Sponsor Sign)
1) __________________________

Individual Shooter $100.00

Firing Station Sponsor Only $100.00 (sign at firing station)

2) __________________________
3) __________________________

Lunch Sponsor $250.00 (Company Sponsor Banner at Lunch Area)

Name:

____________________________________________________

Company:

____________________________________________________

Address:

____________________________________________________

City:

_____________________________ St: ______ Zip: _________

Phone:

_______________________ Email: ______________________

4) __________________________

Payment Method:
Check
Credit Card

Credit Card No.

___________________________________________ Exp Date: _______________

Security Code:

_____________

Signature:

_________________________________________

Credit Card Info if Different Than Above:

Please Return or Fax Form To:

Florida Seed Association, Inc.
2161 East CR 540A, PMB 236
Lakeland, Florida 33813
Fax: 863-582-9363
awood92014@aol.com

Name:

________________________________________________________

Company:

________________________________________________________

Address:

________________________________________________________
City: ________________________ ST: ________ Zip: ____________

Phone:

____________________________ (phone number associated with credit card billing)

If you have any questions please call us at 863-660-6540