Entry Form

The Arkansas State University Paintball Club & Team

Event Entry Form

Event Name

_______________________________________________________________________

Team Name

_______________________________________________________________________

Team Captain

_____________________________________________________________________

Address

_____________________________________________________________________

Phone Number

____________-______________-__________________________

E-mail Address

______________________________________@____________________________

I the undersigned do hereby agree to abide by the rules of the above named event.

I understand that any Money submitted at this time is non refundable.

_________________________________________________________________________________

(signature)

Amount Submitted:

$________________________

(circle one)Check/Money Order/Cash

(Returned checks subject to $30 return check fee and forfeiture of entry into this event)

For additional information:

Call: 268-6960

Print This Form, Fill out and Send to:

Arkansas State Paintball Club & Team

C/o Brad Deckard

2410 Mary Jane

Jonesboro, AR 72401