League Name:  Bowlers Name:   

Bowlers USBC Card Number:

Date of Achievement:      

Series or Games: Game 1:    Game 2:   Game 3:   Series:

If based on this years new 12 game average: Average:   Number of Games:

If based on last years book average: Average:  Number of Games:

I certify that the above information is correct: Secretary's Name: