USBC High Score Application - Minneapolis USBC Bowling

PREMIUM 300 GAME AND
800 SERIES AWARDS
11 IN A ROW AWARD ON BACK
STEP 1: Choose Your Style
MEN’S PRESTIGE (Sizes 7 – 18)
LADIES’ PREMIER (Sizes 3 – 15)
LADIES’ PRESTIGE (Sizes 3 – 15)
300 GAME
300 GAME
300 GAME
800 SERIES
800 SERIES
800 SERIES
STEP 2: Choose Your Metal
MEN’S PRESTIGE
Siladium Golden Siladium
Siladium Two-Tone
10K Yellow Gold
14K Yellow Gold
®
No Charge
$50.00
$200.00
$625.00
$875.00
Siladium Two-Tone
Prestige
LADIES’ PRESTIGE
Siladium®
Golden Siladium
Siladium Two-Tone
10K Yellow Gold
14K Yellow Gold
LADIES’ PREMIER
No Charge Siladium®
$50.00
10K Yellow Gold
$160.00
14K Yellow Gold
$425.00
$525.00
No Charge
$315.00
$400.00
STEP 3: Choose Your Side Personalization
No Personalization
No Charge
Date Bowled
Two lines of text
(9 characters)
LADIES’ PREMIER
Diamond Accent Stones
$60.00
Number of times
score bowled
Personalized Design
$25.00
STEP 4: Choose Your Top Options
PRESTIGE TOP PIN OPTIONS
Classic Pin
No Charge
Personalized Pin
(3 characters)
$10.00
DiamondAccent Pin
$60.00
PRESTIGE PANEL/STONE OPTIONS
Signet Panel
(Standard)
No Charge
LADIES’ PREMIER – Choose Your Stone
Ladies’ Premier
(Standard)
No Charge
CZ Zenith-Set
Stone
$50.00
Lab-created Ruby
300 Game Only
$25.00
10K Yellow
Gold Panel
$75.00
Genuine Amethyst
800 Series Only
$25.00
Diamond
Zenith-Set Stone
$150.00
After your award is certified, Keepsake will contact you directly for payment. Please provide daytime contact
information to expedite your order.
Once you receive your letter or email confirming your award certification, you may contact Keepsake directly
at 1-800-982-6515 to expedite your upgraded award.
Notify league processor within 48 hours of 300 game or 800 series. Application must be submitted to league processor within 20 days of score.
keepsakebowling.com
SEE BACK SIDE FOR ORDER FORM
Order can not be processed unless all fields are complete.
2013-2014 ADULT AND YOUTH HIGH SCORE APPLICATION: for 11-in-a-Row, 300, 800.
Center Name: ______________________________ Center #: _______________________________
Competition Type
Center Address: ____________________________________________________________________




Address City/State/Zip
Competition Name: _________________________ Competition #: __________________________
Competition Official: ________________________________________________________________
Print Name
Address
City/State/Zip
(Check one)
League
Tournament
Interscholastic
Modified Format
(scoresheet attached)
Bowler's Name: ________________________________________________________________ Bowler's ID#: ________________
Last Name
First Name
Street Address
Apt. #
M.I.
Bowler's Address: ______________________________________________________________ Date of Birth: ________________
______________________________________________________________________________ Membership:  Adult  Youth
City
StateZip
(
)
E-mail: _____________________________________ Day Phone: _________________________
Gender:
Bowled with:
 Female
Bowler's Assn. Name: __________________________ Assn. Number: ___________________  Male
 Right hand
 Left hand
Date Bowled: _______________________________
_______ _______ _______
___________________________________________
______________________ Serial Number on Ball:
MMDD
Year
Ball Manufacturer
Game 1
Game 2
Game 3
_______
Series Total
________
Average ________
No. of Games
 Yes
 No
Were all rules observed when score was bowled?
Ball Model
 Yes  No (if no attach explanation)
X
Competition Official Signature: _________________________________________
USBC Youth members have the obligation to be aware of any restrictions that may be in
place by his/her high school athletic associations that may affect any outside competitions
they could compete in or limitations on awards that they may earn.
Note: See USBC Playing Rule 3 for modified competition formats.
Bowler's Signature: __X_____________________________________________
Was the game(s) pre/post bowled?
 Yes
 No
Please ship award to:
 Directly to me at the above address
 Association
 League Official
 Other:
I verify that all information relative to the high score bowled is correct.
USBC ACHIEVEMENTS Approval can be found on bowl.com
Choose Your Award
 300 Game Please note if this
achievement is:
 First achievement for this score in this season.
Please select award below.  800 Series  11-in-a-Row
 Multiple achievement for this season. Do not select an award on this form. (Additional ring awards
may be purchased at Keepsakebowling.com. For Trophies and plaques contact USBC Headquarters 800-514-2695)
 Men’s Prestige Ring
 Ladies’ Prestige Ring
 Ladies’ Premier Ring
Other Awards
Finger Size ___.___ (sizes 7-18)
Finger Size ___.___ (sizes 3-15)
Finger Size ___.___ (sizes 3-15)
 11-in-a-Row Crystal Award
Men’s Metal Choice (Choose one)
 Siladium No Charge
 Golden Siladium $50.00
 Siladium Two-Tone $200.00
 10K Yellow Gold
$625.00
 14K Yellow Gold
$875.00
Ladies’ Metal Choice (Choose one)
 Siladium No Charge
 Golden Siladium $50.00
 Siladium Two-Tone $160.00
 10K Yellow Gold
$425.00
 14K Yellow Gold
$525.00
Metal Choice (Choose one)
 Siladium No Charge
 10K Yellow Gold
$315.00
 14K Yellow Gold
$400.00
Premier Side Personalization
(Choose one)
Prestige Side Personalization (Choose one)
 CZ Accents  Diamond Accents  Standard Side  Custom Side Premier Center Stone Choice
No Charge
$25.00
(up to 9 characters)
Text Line 2:
(up to 9 characters)
Date Bowled: M
M
-
D
D
-
Y
Y
# of Times Score Bowled: ______
Prestige Panel/Stone Choice
(Choose one)
Prestige Top Pin Choice
(Choose one)
 Signet Panel No Charge
 Classic Pin No Charge
 CZ Zenith Stone $50.00
 Personalized Pin $10.00
 10K Yellow Panel $75.00
 Diamond Zenith Stone $150.00
No Charge
$60.00
(Choose one)
Text Line 1:
(up to 3 characters)
 Diamond Accent Pin $60.00
 300 Game Crystal Award
 800 Series Crystal Award
 CZ (Standard) No Charge
 Lab-created Ruby* $25.00
 Genuine Amethyst* $25.00
* Ruby- 300 Game Only / Amethyst- 800 Series Only
Adult/Youth Donation Options:
 Hall of Fame
 Earl Anthony Fund
 BVL: Bowlers to Veterans Link
 Susan G. Komen for the Cure
 Youth Education Services
 300 Game Plaque
 800 Series Plaque
Youth Other Award Options:
 Youth Scholarship

No award requested for this achievement.