Print out this form and mail or fax to:

Name: _____________________________________________________________ Address: ___________________________________________________________ ___________________________________________________________________ City: __________________________ State: ______________ Zip: ____________ Telephone: _____________________ Telephone Evening: ___________________ SASS Affiliated Club, if any:____________________________________________ Shooting Alias Choice #1:______________________________________________ Alias Choice #2:____________________ Alias Choice #3:____________________ FAMILY MEMBERS: Spouse/Significant Other Name: ________________________________________ Shooting Alias Choice #1:______________________________________________ Alias Choice #2:____________________ Alias Choice #3:____________________ Junior (17 and under): _______________________________ DOB:_____________ Shooting Alias Choice #1:______________________________________________ Alias Choice #2:____________________ Alias Choice #3:____________________ Junior (17 and under): _______________________________ DOB:____________ Shooting Alias Choice #1:______________________________________________ Alias Choice #2:____________________ Alias Choice #3:____________________ Select one:  SASS Shooters Handbook __ SASS Mounted Shooters Handbook __ Select one:  Printed Chronicle __ E-Mailed PDF Chronicle __

SASS Membership Fees
Life Memberships - U.S. Only		Total
$750 (Includes Gold Collectors Edition Badge)	X______	$______________
$500 Senior Life (Includes Gold Collectors Edition Badge)	X______	$______________
Annual Membership Basic Dues - U.S.
$55 Basic Member (Includes 1st year dues)	X______	$______________
$130 Basic Member Fee (Includes 3 years year dues)	X______	$______________
Family Memberships - U.S. Same household with Basic Member, One Cowboy Chronicle per household
$40 Spouse . Significant Other -1 year dues	X______	$______________
$95 Spouse . Significant Other 1 year dues	X______	$______________
$25 Dependents (under 17) - 1 year dues	X______	$______________
$50 Dependents (under 17) - 3 year dues	X______	$______________
International Memberships (All fees US Dollars)
$65 International One Year Basic Dues with PDF Cowboy Chronicle	X______	$______________
$160 International Three Year Basic Dues with PDF Cowboy Cowboy Chronicle	X______	$______________
$55 International Spouse/Significant Other - 1 year dues	X______	$______________
$130 International Spouse/Significant Other - 3 year dues	X______	$______________
$35 International Dependents (under 17) - 1 year dues	X______	$______________
$70 International Dependents (under 17) - 3 year dues	X______	$______________
All Fees U.S. Dollars
Renewals - U.S.
$45 Individual Basic - 1 year dues	X______	$______________
$120 Individual Basic - 3 year dues	X______	$______________
$35 Spouse/Significant Other - 1 year dues	X______	$______________
$85Spouse/Significant Other - 3 year dues	X______	$______________
$20 Dependents (under 17) (You pay only for 1st Junior. All other Juniors are free) - 1 year dues	X______	$______________
$45 Dependents (under 17) (You pay only for 1st Junior. All other Juniors are free) - 3 year dues	X______	$______________
Renewals - International
$55 Individual Basic with PDF Cowboy Chronicle - 1 year dues	X______	$______________
$150 Individual Basic with PDF Cowboy Chronicle - 3 year dues	X______	$______________
$45 Spouse/Significant Other - 1 year dues	X______	$______________
$120 Spouse/Significant Other - 3 year dues	X______	$______________
$25 Dependents (under 17) (You pay only for 1st Junior. All other Juniors are free) - 1 year dues	X______	$______________
$60 Dependents (under 17) (You pay only for 1st Junior. All other Juniors are free) - 3 year dues	X______	$______________
$10 US ONLY - Both Printed and Emailed Copies of the Cowboy Chronicle	X______	$______________
$100 International ONLY - Add Printed Copy of the Cowboy Chronicle	X______	$______________
Total Amount Enclosed		$______________

METHOD OF PAYMENT
Make checks payable to: SASS

Method of Payment: __Check __Cash __Visa __Mastercard __Amex __Discover

Card Number____________________________________________ Exp. Date ____________

Card Holder's Signature_________________________________________________________

Please allow 2-4 weeks for delivery

SINGLE ACTION SHOOTING SOCIETY
23255 La Palma Avenue, Yorba Linda, California 92887
(714) 694-1800; Fax (714) 694-1815 E-Mail: sass@sassnet.com
www.sassnet.com
All contents copyrighted 2000-2005