2014 PMA ANNUAL STATE POOL TOURNAMENT APRIL 4 - 6, 2014 Hosted by the Millerstown Moose Family Center Lodge 925 109 Juniata Parkway West, Millerstown, PA 17062 Phone: 717.589.7544 Website: millerstownmoose.com E-mail: [email protected] Facebook: Millerstown Moose Lodge 925 Local Hotels/Lodging Econo Lodge - US Route 322, Mifflintown, PA 17059 Ph: 717.436.5981 www.econolodge.com Red Carpet Inn - 3270 Susquehanna Trail, Duncannon, PA 17020 Ph: 717.834.3320 Knights Inn - 4268 William Penn Hwy, Mifflintown, PA 17059 Ph: 717.436.2127 Microtel Inn & Suites - 4900 Woodland Drive, Enola, PA 17025 Ph: 717.635.2523 Plus other hotels towards Lewistown, PA Mail entry forms and make $110.00 checks payable to: Millerstown Moose Family Center Lodge 925 PO Box 710 Millerstown, PA 17062 Deadline for entries is March 17, 2014 (No onsite entries will be accepted) Entry fee $110 Each team MUST complete an entry form. All shooters MUST have a paid up dues card or receipt at time of registration to be admitted into the tournament. Unsportsmanlike conduct will NOT be tolerated at this tournament; any shooter in violation will be required to leave the property, disqualified from further tournament play and will forfeit any prize money and/or awards. NO EXCEPTIONS !!! Please print legibly. Thanks. Team Captain:___________________________ MID#_________________ Dues Expire:____________ Member:________________________________MID#_________________ Dues Expire:____________ Member:________________________________MID#_________________ Dues Expire:____________ Member:________________________________MID#_________________ Dues Expire:____________ I CERTIFY THAT THE ABOVE PARTICIPANTS ARE PAID-UP AND IN GOOD STANDING WITH OUR LODGE/CHAPTER. I ALSO CERTIFY THAT OUR LODGE/CHAPTER HAS PAID-UP PMA DUES THAT COVERS THIS TIME PERIOD. _______________ ____________________________________________ DateAdministrator/Recorder signature