c/o Jeff Lutz, 10569 Allentown Blvd, Annville, Pa 17003
(717) 534-5506 or (717) 507-4121 --------> www.PaSportingClays.com
Club Name:____________________________ Shoot Date:________________
NSCA Shoot#:_______________
Number of Targets: _________ x $0.03 per target = ____________
Club/Range Memberships: _________ x $25 per Range = ____________
Total ____________