USBR International Postal Match Registration & Entry Form

(Print this form. Send completed form and entry fees (US Dollars only) to the address at the bottom of the form) (Complete a new form for each gun entered)

Your Name: ____________________________________________________________________

Mailing Address: ________________________________________________________________
   
                 __________________________________________ Country:______________

Telephone: _____________________________ E-Mail _________________________________

Division: Senior(over 16 years) _____  Junior (16 years or less)  _______ 

Entry Class: Plinker  _____    Sporter  ______   Custom _____ Unlimited _________

Caliber: .22 ______    .17 ______

Gun Manufacturer & Model: ___________________________________________________

Gun value in Dollars: $_________________ (USD ONLY)

EQUIPMENT LIST:

Sights: Open ____  Scope_____   Mfg & Model:_______________________________________

Power: _____ Rings: ______________________Front  Rest: _____________________________  

Rear Rest:____________________ Trigger: _________________ Ammo:__________________

FEES:   

1. Number of Senior Entries _______ x $5.00 ea. = $____________ (USD ONLY)

2. Number of Junior Entries _______ x $3.00 ea. =  $____________ (USD ONLY)

Up to TWO packets of practice targets can be ordered when you enter a match.

___ 1. or _____2. practice packets (10 targets per packet) @ $6.00 per packet = $________(USD)

Total Fees enclosed: $_____________

Make your check or money order (no cash please) payable to:    John E. Petteruti

Send completed forms and fees to:  USBR International Postal Match
                                   c/o John Petteruti
                                   6700 Whitaker St.
                                   Dayton, OH 45415
                                   937-454-5197