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1
Team Gostar Match BPSA 10 8
9/12/2007
Team Gostar
Match BPSA 10 8 9/12/2007
Squad Registration Form
Individual Registration Form
Name .. Adress

Club
Name .. Adress

Club

City .Code .Country
. PhoneFax ..
.

City .Code .Country
. PhoneFax ..
.
Name
Club
Division
Factor
DIVISION Caliber
Class
1
2
Open Standard Modified Production revolver
Lady Senior S.S
Major Minor
3
4
5
6
If 2nd choise not available
7
1st choice
2nd choise
Reimbourse
8
Sat AM
Sat AM
Phone ore fax for another appointement
Sat PM
Sat PM
9
Sun AM
Sun AM
10
Sun PM
Sun PM
Squadding
If 2nd choise not available
I want to be squadded with Reginal
director approval..Shooter signature.
1st choice
2nd choise
Reimbourse
Sat AM
Sat AM
Phone ore fax for another appointement
Sat PM
Sat PM
One shooterone registration formone check
Sun AM
Sun AM
Sun PM
Sun PM
Info and mail form/ check to
Schampheleer Dirk Hoogstraat 19
Account 755-4249708-94
9260 Schellebelle
Squad registration same time and day one check
Tel [phone]
Fax [phone] GSM0475/85.85.33 E-mail
bpsa_at_gostars.be