2011 Wild Goose Skeet Shoot - Registration

Name

Name that appears on your Credit Card

Name that appears on your Credit Card :: This is the name that appears on the credit card that you will use to pay the registration fee through PayPal. This will help us match your payment with your registration form.

Address

City

State

Zip Code

Phone

Phone :: Enter phone number in the following format: 1234567890

Email Address

Have you completed a gun safety program?

Yes
No

Participant/Guardian Signature

Entering your name in the box above I indicate that I are aware of the risks and hazards of skeet shooting in general and this event in particular. I represent that I am capable of carefully handling a gun in this event. I assume all risks regarding my participation in this event, even if those risks are caused by the negligence of someone else. I discharge and release forever the Delta Area Chamber of Commerce and any other sponsors or organizers together with their respective officers, agents, employees, and other representatives of any liability whatsoever for any claim or damage, injury, or death that may happen as a result of my participation in this event. I understand that there is no obligation to provide me with medical care as a result of my participation in this event, but that if such emergency care is provided, all of the terms of the agreement shall apply. The organizers of this event may use my likeness, records, or photograph for any purpose without compensation to me. As a parent of the participant, I understand and accept that all the above conditions apply to both of us.

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