NASC Registration Form

NASC
North American Sniper Championship
Sponsored by the Mississippi Tactical Officers' Association

March 26-29, 2012

SOUTHAVEN, MISSISSIPPI POLICE TRAINING COMPLEX

REGISTRATION FORM

DATE: Fri, 05/18/2012 - 23:22
IP ADDRESS: (for security)

DEPARTEMENT/AGENCY INFORMATION:

AGENCY NAME MAIN *

ENTER YOUR AGENCY NAME HERE

CONTACT PERSON MAIN *

ENTER THE CONTACT PERSON

MAILING ADDRESS MAIN *

ENTER YOUR PREFERRED MAILING ADDRESS

TELEPHONE MAIN *

ENTER THE PREFERRED CONTACT NUMBER

COMPETITOR INFORMATION:

Shooter #1:

NAME 1 *

MAILING ADDRESS 1 *

ENTER SHOOTER #1 MAILING ADDRESS

TELEPHONE 1 *

ENTER THE PREFERRED CONTACT NUMBER

EMAIL ADDRESS 1 *

ENTER SHOOTER 1 EMAIL ADDRESS

TSHIRT 1 *

Enter your shirt size.

COMPETITOR INFORMATION:

Shooter #2:

NAME 2 *

MAILING ADDRESS 2 *

ENTER SHOOTER #1 MAILING ADDRESS

TELEPHONE 2 *

ENTER THE PREFERRED CONTACT NUMBER

EMAIL ADDRESS 2 *

ENTER SHOOTER 1 EMAIL ADDRESS

TSHIRT 2 *

Enter your shirt size.

PAYMENT INFORMATION

DATE: Fri, 05/18/2012 - 23:22
IP ADDRESS: (for security)

FILL OUT THE BELOW INFORMATION REGARDING YOUR PAYMENT METHOD.

AGENCY NAME PAYMENT *

ENTER YOUR AGENCY NAME HERE

CONTACT PERSON PAYMENT *

ENTER THE CONTACT PERSON

BILLING ADDRESS PAYMENT *

ENTER YOUR PREFERRED MAILING ADDRESS

PAYMENT METHOD *

PURCHASE ORDER - include PO NUMBER BELOW

CHECK IN ADVANCE

CHECK or CASH AT EVENT

SELECT ONE METHOD OF PAYMENT

PO NUMBER

IF YOU SELECTED PO NUMBER ABOVE - INCLUDE IT HERE.

MAKE ALL CHECKS PAYABLE TO: MISSISSIPPI TACTICAL OFFICERS' ASSOCIATION.

PRINT THIS FORM FOR YOUR RECORDS AND BRING IT WITH YOU TO THE EVENT.

FORWARD ALL PAYMENTS BY MARCH 1, 2011 TO:

MISSISSIPPI TACTICAL OFFICER'S ASSOCIATION
LT. RANDY RUFFIN
4 Northwood Place
Clinton, MS. 39056

PH: 601-214-3344

IMPORTANT:

Be sure and read over the Information Packet and Sign and submit the waiver forms with your payment.

Search form

You are here

NASC Registration Form

Amber Alerts