HALL OF FAME Award Entry Form

Owners Name:
Street Address:
Town:
State:
Zip:
Telephone:
For Performances in: Young Birds We hereby certify that the above data represents the true performance of the bird entered in this record and we are a paid-up I.F. Member:
  Old Birds
Club Affiliation: Owner:
Band No: Club Secretary:
Color & Sex: Club President:

This Entry Form must be signed by the Officer of the Organization you are submitting your race results for!
Combine results submitted; Combine officer’s signature required.
Club results submitted; Club officer’s signature required.

SUBMIT TO:
Walter Cichon
PO Box 436
West Islip, NY 11795
Phone: 631-422-0446
Email: Pigeon0446@hotmail.com
DATE OF FLIGHTDISTANCE TOTAL # OF LOFTSTOTAL # OF BIRDSYOUR POSITIONYOUR SPEEDWINNER’S SPEED# OF BIRDS YOU ENTERED

To receive a copy of your submission please enter email here.