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THIS PAGE HAS NOT BEEN UPDATED FOR 2001

Dues & Registration:

Name:

Address:

City:

State/Prov:

N-SSA #

Zip/Post. code:

Phone:

Fax:

E-mail:

Please register for the following activities.

$45.00

N-SSA DUES (before 12/1)

N-SSA DUES (after 12/1)

$48.00

Patches: 4 shoots @ $2.00 ea.

$  8.00

Trailer Fee, annual fee for parked trailers

$10.00

Cannon Fund

Spring National:

Musket

50 yd

100 yd

Agg

Carbine

50 yd

100 yd

Agg

Br. Loader

TRAILER INFO:

50 yd

100 yd

Agg

Revolver

25 yd

50 yd

Agg

Type:

Musket/Carbine

Agg

Grand Agg

Pop-up

Sp. Nat Indiv. Total

5th Wheel

Fall National:

Motor Home

Musket

Hard shell

50 yd

100 yd

Agg

Carbine

Other

50 yd

100 yd

Agg

Br. Loader

Manufacturer:

50 yd

100 yd

Agg

Revolver

25 yd

50 yd

Agg

Musket/Carbine

Agg

Grand Agg

Description:

Fall. Nat Indiv. Total

Length, ft

Individual Matches, $1.25 ea.

#

Age, yrs

General condition:

Extra Team Matches:  (team captain enter only)

Excellent

Event

Mortar

Carbine

Revolver

Good

Spring National,

$15

$30


$15



Fair



Fall National,

$15

$30

$15


Poor


Spring Regional,

$15


- - - 

$12

Describe Problems:

Msn. Dxn, 100 yd,

$15

$30


$12



Msn. Dxn, 200 yd,

$15

- - -   

- - -



Fall Regional,

$15


- - - 

$12

Total Extra Team Matches


Grand Total:  (total of all blue boxes)


Print  this form & mail payments to:
Al Cox
727 Little New York Road, Rising Sun, MD  21911

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