RANFURLY/NASEBY PISTOL CLUB

MEMBERSHIP FORM

P O Box 43, Underwood 4119, Queensland, Australia

Please Print Clearly and Include $5 Fee With This Form

SURNAME:

FIRST NAMES

PREFERRED NAME:

POSTAL ADDRESS:

E-MAIL ADDRESS:

PHONE NUMBER:

FAX NUMBER:

MALE / FEMALE

SENIOR / JUNIOR

CURRENT CLUB:


Match Master A Grade B Grade C Grade D Grade
Mens Air 575+ 560-574 540-559 500-539 0-499
Womens Air 380+ 365-379 350-364 320-349 0-319

AIR PISTOL CRADE (As Listed Above):



DO YOU LIKE CHOCALATE FISH?
YES / NO / DON'T KNOW
WHAT SIZE IS YOUR CYCLE HELMET SIZE?
SMALL / MEDIUM / LARGE / XL LARGE / WHO CARES


WELCOME TO "THE" CLUB OF NEW ZEALAND