2015 Great Eastern Lobster Classic & The Silver Cup World Veterans

Sporting Clays & FITASC Championships

~ sponsored by Randolph Ranger ~

Please fill out and return to: Addieville East Farm, 200 Pheasant Drive, Mapleville, RI 02839
Tel: (401) 568-3185 Fax: (401) 568-3009 Email: Website:

Name: ______NSCA # ______NSCA Class: ______

Address: ______NSCA Concurrent: ______FITASC Concurrent: ______

City: ______State: _____Zip: ______Email: ______

Fax: Day Phone: Eve. Phone:

Check Charge my: Visa Master Card American Express

Card # ______-______-______-______Exp:____/_____ CVV#______Signature: ______

EVENTS INCLUDE ALL NSCA FEES / Cost / Total / MAIN EVENT ROTATIONS
Please denote your first choice with a 1, your second and third choices with a 2 or 3. Confirmations will be mailed or emailed. If you do not receive one please let us know as soon as possible.
Main Event (Paid and received by August 1) / $215
Main Event (After August 1) / $230
Juniors & Sub-Juniors (ineligible for purse) / $100
** Main NSCA Class Option cash/check only / $10 /

Rotati`on

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Saturday

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Sunday

Rotation

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Saturday

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Sunday

***Main NSCA Lewis Class Option cash/check only / $10 /

1.

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8:00 am

/

11.00 am

* World Vet Champ NSCA Class Opt. cash/check only / $10 / 2. / 11:00 am / 2.00 pm
RHO Preliminary (100 targets) / $100 / 3. / 2:00 pm / 8.00 am
Prelim. Juniors & Sub-Juniors (ineligible for purse) / $50 / PAID Entries MUST be submitted together in the same fax or envelope for squad preference!! PLEASE, NO PHONE ENTRIES
** NSCA Class Option Prelim. cash/check only / $10
*** NSCA Lewis Class Opt. Prelim. cash/check only / $10
12 gauge (50 targets) / $45^ / 1. (Yourself)
410 bore (50 targets) / $45^ / 2.
28 gauge (50 targets) / $45^ / 3.
20 gauge (50 targets) / $45^ / 4.
Pump (50 targets) / $45^ / PRELIMINARY FLIGHT TIMES
Side by Side (50 targets) / $45^ / 1. 8:00 am 2. 11:00 am aa.m.aaa.m.ppppp.m.
5-Stand Tournament ● Fri ●Sat ● Sun / $60 / 3. 2:00 pm
FITASC (100 TARGETS)  ●THURS/FRI ●SAT/SUN / $125 / PRELIMINARY SQUAD
** FITASC NSCA Class Opt. cash/check only / $10 / 1. (Yourself)
*** FITASC NSCA Lewis Class Opt. cash/check only / $10 / 2.
*FITASC World Vet Class Option cash/check only / $10 / 3.
Banquet (Choose) •Lobster •Steak (not incl.) / $35 pp / 4.
Golf Cart rental per day •Thurs •Fri •Sat •Sun / $60 / *Split 60/40 High Gun ** 50/30/20 High Gun
*** 5-class split 50/30/20 High Gun
^ $50.00 if paid after Aug 1
OPTION MONEY TO BE MAILED
YOU MUST SIGN WAIVER ON BACK
Grand Total / -----
● Please circle your preference

RELEASE AND ASSUMPTION OF RISK

I hereby expressly assume any and all risks associated with shooting on Addieville East Farm, Burrillville, Rhode Island. I know shooting is considered by many to be dangerous, and I hereby assume the risk of any and all injuries I may suffer due to the physical condition of Addieville East Farm, the acts or omissions of other shooters who may be on or near Addieville East Farm, whether with or without permission, equipment failure, acts of God and/or for any other reason.

I have been advised that there will be other persons shooting and carrying firearms on Addieville East Farm, and I agree to act prudently and carefully to avoid causing them any injury. I certify that I am familiar with the use and operation of the firearm(s) I will be using while on Addieville East Farm and that I am familiar with the rules of shooting and firearm safety.

I release Morris J. Gaebe and Addieville East Farm, Inc., Addieville East Conservation Club, Inc., Four Ten Farm, LLC, together with all their employees, agents and representatives including, without limitation, Paula Gaebe, for any and all claims for personal injury, wrongful death, and/or property damage which may arise in my favor and which may occur during or as a result of my presence on Addieville East Farm as referenced above regardless of the cause of any such injury and including those which may be caused by negligence and/or any other cause.

I give this release and assume all the risks attendant thereto in consideration of being allowed to enter into and shoot at Addieville East Farm.

This “release and assumption of risk” will be binding on my heirs, executors and assigns.

I HAVE READ THE ABOVE DOCUMENT.

______

Signature Date

Social Security Number: ______In order for us to legally distribute monies, we need this. No monies can be mailed without this.

In accordance with NSCA rules, shoot management may refuse any entry or cause the withdrawal of any entrant who annoys, endangers or interferes in any way with the harmony of the shoot. Management’s decisions are final.

ACCOMODATIONS

Holiday Inn Express 401-231-6300 (Code 100276058)

All Seasons Inn & Suites 401-232-2400

Hampton Inn 401-232-9200 (Pet Friendly)

Marriott Courtyard – 401-333-3400

Ask for the Addieville East Farm Special room rate when making your reservations.