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Entry Fees

The Single Action Shooting SocietyHosted by The Pemi Valley Peacemakers

Present

SASS New Hampshire State ChampionshipsAugust 24 - 26 2018

Please use one registration form for each, copy form for each shooter, total on first page. Entries are limited to the first 150.SASS rules apply - Must be a SASS Member to shoot.

Make Checks Payable to:Pemigewasset Fish and Game Club

Mail to:Joe Morris5 Meadow WayThornton NH 03285

Match Questions:Dakota Joe - Match Directoraka: Joe Morris5 Meadow WayThornton NH 03285Phone - 603-620-5001 dakota814@msn.com

Free Camping Free camping on club grounds, No Hookups - Type of camping, Tent___ Camper___ Length & Width ___________

Visit our website for more information: www.pemipeacemakers.com

Confirmation Confirmation letter will be sent with schedule and accommodations by email unless self addressed stamped envelope is sent with entry. Pemi Vally Peacemakers and the Pemi Fish and game Club reserve the right to refuse any application.

Entry Form

10 CAS Main Stages - 6 on Saturday August 25 and 4 on Sunday August 26thFriday Side Matches Include Warm-up, Plainsman, Wild Bunch, Long range, and Speed Events

Fracas at Pemi GulchFracas at Pemi Gulch

Main Match -10 Stages $75.00 $ Spouse/Significant Other $50.00 $ Young Adults (17-22) $50.00 $ Junior (14-16) (must be accompanied by an adult) $25.00 $Buckaroos (under 14) (must be accompanied by an adult) Free Saturday Evening BBQ $20.00 $ Extra Saturday Evening BBQ tickets $20.00 $ Friday Side Events – All side events and mini-matches $15.00 $ Friday Side Events – No charge if you work one hour $00.00

TOTAL $

B-Western Classic Cowboy Cowboy Duelist Frontier Cartridge

FC Duelist FC Gunfighter Frontiersman Gunfighter Buckaroo (13 & under)

Junior (14-16) Wrangler (36+) 49er (49+) Senior Duelist (60+) Senior (60+)

Silver Senior (65+) Elder Statesman (70+) Cattle Baron (75+) El Patron (80+)

Please Check ____ MALE or ____ FEMALE and check one category below

Name _______________________________________________________________ SASS # ____________________

Alias _____________________________________________________ RO 1 ( ) RO 2 ( ) Willing to be Posse Marshal ( )

Street _____________________________________________________ Willing to work 1 hour shi� at Fri. side matches ( )

City ___________________________________State _________Zip ________ Phone __________________________

Email ______________________________________Share equipment with __________________________________

Posse with (if possible) ____________________________________________________________________________

PEMIGEWASSET VALLEY FISH & GAME CLUB, INC.

LIABILITY RELEASE / WAIVER OF RIGHTS / HOLD HARMLESS AGREEMENT

I understand that I am participating in a sport in which certain dangers and risks may arise, including, but not limited to, accidental

injury. In consideration of the right to participate in these events, and the services provided for me by the PEMI VALLEY FISH AND

GAME CLUB - PEMI VALLEY PEACEMAKERS AND THE SINGLE ACTION SHOOTING SOCIETY and their agents collectively

and individually, I have and do hereby assume the risks associated with such events.

To the extent not otherwise covered by an insurance policy, the contestant shall: 1) at his or her own expense defend management

and/or all sponsors, their members, or employees from any and all such claims and indemnify, from any and all liability, damage

and costs arising from injuries to person(s) or property occasioned by any act or omission of the contestant, and 2) waive the right

to seek recovery for any injury or damages suffered by the contestant while participating in any SASS Cowboy Action Shooting

event at the PEMI VALLEY FISH AND GAME CLUB. The Pemigewasset Fish & Game Club, Inc. DO NOT WARRANT AND DO

NOT GUARANTEE insurance is available or that, if available, it will provide coverage for any particular loss of any nature and/or

kind, injury, dismemberment or death.

By my signing below, I the participant, acknowledge that I have read this form, I understand this form, and I AM WILLINGLY,

KNOWINGLY AND VOLUNTARILY WAIVING ALL OF MY RIGHTS, LEGAL AND OTHERWISE, and I FURTHER AGREE to all of

the terms, conditions and restrictions contained in this RELEASE OF LIABILITY / WAVIER OF ALL RIGHTS/HOLD HARMLESS

AGREEMENT FORM.

Eye and hear protection is mandatory and it is the shooter's responsibility to comply with this requirement.

If you, the participant, are in any way uncomfortable with a COMPLETE AND TOTAL RELEASE of your right to seek recovery for

any claim, loss and/or injury, dismemberment or death you sustain while at the Pemigewasset Fish & Game, Inc. Event, you should

not sign this form, in which case you will be asked to leave the premises.

Name: ____________________________________ Event Date: _________________

Signature: ______________________________

Signature of Parent/Guardian If Participant is a Minor: ___________________________