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The Single Action Shooting Society Hosted by The Pemi Valley Peacemakers
Present
Fracas at PF emi Gulchracas at Pemi GulchSASS New Hampshire State Championships
July 7 - 9 2017 10 CAS Main Stages - 6 on Saturday July 8th and 4 on Sunday July 9th
Friday Side Matches Include Warm-up, Plainsman, Wild Bunch, Long range, and Speed Events
Entry Form 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.
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 ______________________________________Posse with (If possible) _________________________________
Categories (pick one)
49er B-Western Classic Cowboy Cowboy Duelist Elder Statesman (70+) Cattle Barron (75+) Grand Patron (80+) Frontier Cartridge FC Duelist
FC Gunfighter Frontiersman Gunfighter Senior (60+) Senior Duelist (60+) Silver Senior (65+) Wrangler (36+) Buckaroo (13 & under) Young Gun Boy (14-16)
Ladies 49er Ladies B Western Classic Cowgirl Cowgirl Ladies Duelist Grand Dame (70+) Cattle Baroness (75+) Grand Patrona (80+) Ladies Frontier Cartridge Ladies FC Duelist
Ladies FC Gunfighter Ladies Frontiersman Ladies Gunfighter Ladies Senior Ladies Senior Duelist Ladies Silver Senior Ladies Wrangler (36+) Buckarette (13 & under) Young Gun Girl (14-16
Entry Fees Main Match -10 Stages $75.00 $ Spouse/Significant Other $50.00 $ Young Adults (17-22) $50.00 $ Young Guns (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 $
Make Checks Payable to: Pemigewasset Fish and Game Club
Mail to: Joe Morris 5 Meadow WayThornton NH 03285
Match Questions: Dakota Joe - Match Director aka: Joe Morris 5 Meadow WayThornton NH 03285 Phone - 603-620-5001 [email protected]
ent___ Camper___ Length & Width ___________Free Camping Free camping on club grounds, No Hookups - Type of camping, T
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.
Visit our website for more information: www.pemipeacemakers.com
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: ___________________________