Registration – Test

First Name *

Last Name

Date of Birth *

Phone *

Email Address *

Address *

Address

City

State/Province

Zip/Postal

Country

Department or Club Affilliation

Are you a registered USPSA member?

If you are a registered USPSA (United States Practice Shooting Association) - Please list the highest class you've achieved among all divisions

Male or Female?

Male

Female

If you previously shot at the Second Chance Combat Shoot please indicate your class:

OSS (Ordinary Standard Shooter)

MB (Master Blaster)

Not Sure

Which event classes are you registering for?

Stock

Importance

Pay for this event

No

Yes

Pin

Importance

Pay for this event

No

Yes

Space

Importance

Pay for this event

No

Yes

Concealed

Importance

Pay for this event

No

Yes

Optional Events

Enter the dollar amount you would like to apply towards optional events.

Number of guests attending with you?

Which days will you be attending?

Will you be camping on site?

Yes

No

Total $

Credit Card Information

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