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