Registration: PSC Junior Action Pistol League
  1. All information marked with (*) is required.
  2. ________________________________________
    ***Parents, please provide the preferred contact information
    (phone & email) for your son or daughter. If you want email
    and calls to go to your child, be sure to provide your
    contact information as well.***
  3. Junior's First Name(*)
    Please type your full name.
  4. M.I.
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  5. Junior's Last Name(*)
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  6. Junior's DOB (dd/mm/yyyy)(*)
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  7. Junior's Age:(*)
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  8. Street & No.(*)
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  9. City(*)
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  10. State(*)
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  11. Zip(*)
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  12. E-mail(*)
    Invalid email address.
  13. Secondary Email:
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  14. Father's Name:
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  15. Mother's Name:
    Invalid Input
  16. Phone Number (xxx-xxx-xxxx)(*)
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  17. Secondary Phone (xxx-xxx-xxxx)
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  18. Is a parent a PSC Member? (Not required for child to participate.)(*)
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  19. If yes, what is the PSC Membership Number?
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  20. Antispam Code:
    Antispam Code:
      RefreshInvalid Input
  21.   

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