Type in your information into this form and then print it out and mail the form with your payment made out to Texas State limited Championship 2012 the address is: 5967 FM 576-E, Breckenridge , Texas 76424
July 21-22, 2012
RO's Shoot: Thursday, July 20
Match Fee: Adult - $125.00 / Juniors - $100.00 - Postmarked Before May 1, 2012 after May 1st, Adult -$150 / Jr.-125.00
Name USPSA#
Address City
State Country Zip
E-mail (for Confirmation)
Phone Number: Match Fee
Division: ___ Limited ___ Production ___1911
Class: ___GM ___M ___A ___B ___C ___D ___U
Category: ___Lady ___Jr ___Sr. ___SSR ___Law ___Mil
Pre Order Shirts: $18.00 ___S ___M ___L ___XL / $22.00 ___2XL ___3XL
Total Number of Shirts_________ Total Price for Shirts_______
Total Price: (Including Match Entry, Shirts and Lunch tickets)__________________