2015 Sporting Clays Event Sponsorship and Registration Form

3rd Annual Foundation Sporting Clays Event Sponsorship & Registration Form Friday, February 6, 2015 10:00 a.m. – 2:00 p.m. FishHawk Sporting Clays Register today, as registration and sponsorships are filled on a first-come, first-paid basis. Form must be completed and returned with payment. All sponsorship payments and company logos must be received by December 31, 2014 to be included in event signage. Please email logos to Lori Diaz at [email protected]. Primary Contact Name: _______________________________________________________________ Company: __________________________________________________________________________ Phone: ____________________________________ Email: ___________________________________ Address: ___________________________________________________________________________ City: _______________________State: _______________________ Zip: _______________________ We want to support the Foundation’s 3rd Annual Sporting Clays Event. Sponsorship Opportunities: Title Sponsor - $5,000 Lunch Sponsor - $2,000 Gift Sponsor - $1,800 Breakfast Sponsor - $1,500 Bus Transportation Sponsor - $1,500 Awards Sponsor - $1,000 Ammunition Sponsor - $800 (4 available) Qty: __________ Special Event Sponsor - $575 Refreshment Sponsor - $500 (2 available) Station Sponsor - $400 (unlimited) Qty: ___________ Registration: (includes 100 sporting clay targets, shotgun shells, luncheon and awards ceremony)  Registration Rate (before January 1st): $200/person Qty: _________ On-site Rate (after January 1st): $250/person. Qty: _________ Total $______________________________

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Method of Payment: Full payment is enclosed (checks must be drawn on a U.S. bank and made payable to: American Traffic Safety Services Foundation).

Check Enclosed: #____________ Please charge my credit card: ____MC ____Visa _____AMEX Account #: _____________________________________________________________________ Exp. Date: ___________________ Security Code (3-digits): ______________________________ Name on Card: __________________________________________________________________ Signature: ______________________________________________________________________ *In consideration for costs and services incurred by the Foundation, it is understood that funds received are non-refundable and the Foundation retains all entry fees.

Participant Information: Please complete all information for each registered shooter. Start time: 10:00 a.m. There are only five shooters per squad. You can register more than one squad. Squad Member #1__________________________ Company: ______________________________ Phone #: ______________________________ Email: ______________________________ Are you bringing your own gun? Yes No

Squad Member #2__________________________ Company: ______________________________ Phone #: ______________________________ Email: ______________________________ Are you bringing your own gun? Yes No

Squad Member #3__________________________ Company: ______________________________ Phone #: ______________________________ Email: ______________________________ Are you bringing your own gun? Yes No

Squad Member #4__________________________ Company: ______________________________ Phone #: ______________________________ Email: ______________________________ Are you bringing your own gun? Yes No

Squad Member #5__________________________ Company: ______________________________ Phone #: ______________________________ Email: ______________________________ Are you bringing your own gun? Yes No

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Please return form with payment to: American Traffic Safety Services Foundation 15 Riverside Parkway, Suite 100, Fredericksburg, VA 22406-1022 or email Lori Diaz at: [email protected] or fax to: 540-368-1717

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