John E. George Memorial Sporting Clays
Tournament
to benefit Chester
River Health Foundation -
Sunday, October 19
Early Registration Deadline - Wednesday, October 8, 2008
(Please print)
Name/Company: ________________________________________________________________
(as you
would like to be listed for recognition purposes)
Contact
Name: ________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
________________________________________________________________
Phone: _________________________ Fax:
____________________________
E-mail: ________________________________________________________________
Sponsorships:
Prize Sponsor:
Donation $________
In-Kind
Gift Description: ______________________________________________
Shooters
(please fill out attached shooter’s information form):
Registration by October 8: Registration after October 8:
$100 per shooter $______ $125 per shooter $______
$75 per junior shooter $______ $100 per junior shooter $______
$400 per team (4 shooters) $______ $500 per team (4 shooters) $______
Lunch:
Additional tickets to luncheon for
non-shooters $20 each
$______
Name
of Guest(s):_____________________________________________________________
Shotgun Raffle:
$5
each or 5 for $20 -- chance to win a Beretta 391 Urika
II gun with 30” barrel and choke tubes
Payment Information:
Total Enclosed $_______
Check payable to Chester River Health
Foundation
Credit Card:
Visa MasterCard American Express Discover
Card Number: __________________________ Exp. Date: __________
Cardholder’s Name: ___________________________________________________
Signature: ___________________________________________________
Please feel free to contact Kenda Leager
at (410) 778-7668, ext. 4013
or e-mail kleager@chesterriverhealth.org
or fax (410) 778-7650
Chester River Health Foundation
100
Brown Street
Chestertown, MD 21620
John E. George Memorial Sporting Clays
Tournament
to benefit Chester
River Health Foundation -
Sunday, October 19
Shooter’s Information
Early Registration Deadline - Wednesday, October 8, 2008
Team Sponsor: _______________________________________________________________
(Please print)
Shooter 1
Shooter’s Name: _______________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: ________________________ E-Mail: _____________________
Senior Shooter (age 60+) Junior Shooter (under 17)
Shooter 2
Shooter’s Name: _______________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: ________________________ E-Mail: _____________________
Senior Shooter (60+) Junior Shooter (under 17)
Shooter 3
Shooter’s Name: _______________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: ________________________ E-Mail: _____________________
Senior Shooter (60+) Junior Shooter (under 17)
Shooter 4
Shooter’s Name: _______________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Phone: ________________________ E-Mail: _____________________
Senior Shooter (60+) Junior Shooter (under 17)
Please feel free to contact Kenda Leager at
(410) 778-7668, ext. 4013
or e-mail kleager@chesterriverhealth.org
or fax (410) 778-7650
Chester River Health Foundation
100
Brown Street
Chestertown, MD 21620