Please use one application per shooter. Copy form for additional shooters.

Name__________________________________Alias______________________________

Address__________________________________________________________________

City ,State & Zip__________________________________________________________

Phone#__________________SASS No. Required__________________________

Check all that apply:  Senior____ Silver Senior___Elder Statesman_____Young Gun____ Buckaroo___Ladies____
Traditional____ Modern____ Duelist____Frontiersman____Frontier Cartridge____ B Western_____
Gunfighter____ Grand Dame___ Forty Niner___ Classic Cowboy___ Classic Cowgirl___

Entry fee of only $115 Per Shooter_____Young Gun $75_____Buckaroo$60_____
(Includes 4 days of shooting, Fri. Night Social , 
Sat. Night Banquet & Lunch for 3 days)

Conventioneer___@$63=____
(Includes Fri. Night Social &Chuck Wagon, Sat. Night Banquet & Lunch for 3 days)

Additional Guest Tickets 

Social ____@$20=_____ Child Social____@$10=____ Banquet____@$25=_____ 
Lunch____@$6 a day=_____Child Banquet___@$10=_____(Children 7& under free)
___ 
RO I Course___@$10=_____   RO II Course____@$25=_____

Total Enclosed________

Print this application through your browser
“Make check payable to SMR”
Mail to: The Southern Missouri Rangers c/o Jeff Dunaway 
672 East Farm Road 20,
Pleasant Hope, Mo. 65725

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