2015 NSW SSAA Single Action State Titles 5th – 7th June 2015 | Newtec Pistol Club, Teralba NOMINATION FORM Name: _______________________________ Alias: _________________________ Address: __________________________________________ Post Code: _______ Email: _______________________________________ Ph: ____________________ SSAA: ______________ SASA: _____________ License Exp: ____________ Match will be shot under current SASS Rules along with Local Range Rules CATEGORY (Please Circle) Cowboy Cowgirl Wrangler Lady Wrangler 49er Lady 49er Senior Lady Senior Silver Senior Lady Silver Senior Grand Dame Frontierman Elder Statesman Buckaroo Buckarette Duelist Senior Duelist Lady Duelist Junior Girl Frontier Cartridge Junior Boy Classic Cowboy “B” Western Classic Cowgirl Lady “B” Western Cattle Baron Gunfighter Side Events – Pat Garrett Friday Morning OR Nomination Fees Primary Entry Secondary Entry Junior Entry Saturday Shindig Total $50 x ____ $45 x ____ $35 x ____ $20 x ____ = _______ = _______ = _______ = _______ = _______ Payment Wild Bunch Friday Morning Cheque (Made payable to Newtec Pistol Club) Cash Direct Deposit BSB: 650 000 Account: 516 807 702 Sharing Guns with ___________________ ________ Please send nomination form with payment to: Newtec Pistol Club. PO Box 4068, Woodrising, NSW, 2284 Nominations close 1st June 2015 – NO LATE ENTRIES For further information please contact Dusty Fog on 0408549042 or via email [email protected] or Dakota Dan on (02) 49761232 or via email [email protected]