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<br />RETURN COMPLETED FORM AND
<br />PAYMENT TO:
<br />ICSC
<br />P.O. Box 26958
<br />New York, NY 10087-6958
<br />Fax: +1732 694 1800
<br />SPORTING CLAY TOURNAMENT CONTACT
<br />Zach Armstrong
<br />Tel: +1832 623 0303
<br />E-mail: zarmstrong@jbeardcompany.com
<br />ICSC CONTACT
<br />Christabelle Flanhardt
<br />Tel: +1646 728 3638
<br />E-mail: cflanhardt@icsc.org
<br />WHEN
<br />Wednesday, November 6, 2013
<br />10:30 am Registration
<br />11:30 am Lunch Served
<br />12:30 pm Shotgun Start
<br />3:30 pm Networking & Awards Presentation
<br />WHERE
<br />Dallas Gun Club
<br />3601 South Stemmons Freeway
<br />Lewisville, TX 75067
<br />FEES
<br />$135 (non-refundable) per player via check
<br />made payable to ICSC. Fee includes 100 targets,
<br />ammunition and barbecue lunch. Please bring
<br />your own shotguns.
<br />Please Note: Space is limited and will be
<br />confirmed on a first-come, first-served basis.
<br />f'brrn r,h.rr,,, old h+rr dupllc W.r d 'f'br rdrJrJi'tir,,,+nal i t l,r ran(,,I r(.%N,trn 'form to ICSC,.
<br />EVENT SPONSOR
<br />A dent ,
<br />PLATINUM SPONSORS
<br />l..
<br />HUNT
<br />im
<br />Average score out of 100 clays: %
<br />Name
<br />Company
<br />Address
<br />City
<br />State/Province
<br />Zip/Postal Code
<br />Telephone
<br />Fax
<br />E-mail
<br />Your ICSC Membership I.D.#
<br />❑ Please check here if any of the above information has
<br />recently changed.
<br />Method of payment
<br />❑ Check made payable to ICSC enclosed for $
<br />MasterCard visa
<br />❑ AMEX ❑ Discover $
<br />Name (as it appears on credit card)
<br />Credit Card Number (include all digits)
<br />Signature
<br />Expiration Date (month/year)
<br />2013TX-B
<br />Release of Claims (Read Carefully and Sign)
<br />I agree and acknowledge that I am participating in the ICSC Texas
<br />may sustain as a result of participating in any and all activities
<br />to me or my heirs arising out of or in any way connected with my
<br />Conference and Deal Making Sporting Clay Tournament ("Sports
<br />connected with or associated with the Sports Event.
<br />participation in the Sports Event.
<br />Event") on my own accord. I give this acknowledgement freely and
<br />In consideration of the right to participate in the Sports Event, I
<br />I further agree to indemnify, defend, and hold harmless the
<br />knowingly and I represent and warrantto you that I am physically
<br />hereby waive any and all rights or claims I may have as a result of
<br />International Council of Shopping Centers, Dallas Gun Club, and
<br />and mentally fit and that, as a result, able to participate, and I do
<br />participation in the Sports Event against the International Council of
<br />their respective directors, officers, employees, members, staff, and
<br />hereby assume responsibility for my own well-being.
<br />Shopping Centers, Dallas Gun Club, and their respective directors,
<br />all individuals assisting in instructing, sponsoring and conducting
<br />I am fully aware that possible physical injury might occur to me
<br />officers, employees, members, staff, and all individuals assisting in
<br />these activities, from any and all claims resultingfrom injuries,
<br />as a result of my participation, and I agree to assume the full risk,
<br />instructing, sponsoring and conducting these activities, and I hereby
<br />including death, damages, or loss, which may accrue to me or my
<br />including risk which is not specifically foreseeable, of any injuries,
<br />fully release and discharge them from any and all claims resulting
<br />heirs arising out of or in any way connected with my participation in
<br />including death, damages or loss regardless of severity, which I
<br />from injuries, including death, damages or loss, which may accrue
<br />the Sports Event.
<br />Signed Print Name Date
<br />
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