Register for Shoot Out Register for Shoot Out * Shoot Out Team Sponsorship - $400 Shoot Out Breakfast Sponsor - $500 Shoot Out Lunch Sponsor - $500 Shoot Out Shells Sponsor - $600 Shoot Out Targets Sponsor - $600 Shooting Prizes - $850 Refreshments - Provide Water, Soda, Gatorade, & Snacks Team Sponsor Name * Team Sponsor Name First First Last Last Title Organization * Phone * Email * Attending Educational Event & Breakfast * YES NO Attending Lunch & Learn * YES NO Attending Shoot Out * YES NO Do you have your own gun? * YES NO SICHE has a list of shooters to help fill your team. Do you want to use this list? * YES NO Team Member #1 Team Member #1 First First Last Last Team Member #1 Email Team Member #2 Team Member #2 First First Last Last Team Member #2 Email Team Member #3 Team Member #3 First First Last Last Team Member #3 Email Team Member #4 Team Member #4 First First Last Last Team Member #4 Email Team Member #5 Team Member #5 First First Last Last Team Member #5 Email Payment Options * Pay Online with Credit Card Mail Check to Southern Illinois Chapter for Healthcare Engineering, PO Box 192, Carbondale, IL 62903 Total Credit Card Captcha If you are human, leave this field blank. Submit
