Surname: First Name:

Address: Suburb:

State: Post Code: Date Of Birth:

Club: ACTA Membership No (or other club):

Please Tick where applicable
By the payment of a full/reduced nomination I am entering the:

Open Womens Junior

** Note: Reduced Nomination fees are applicable to Juniors.
Shooters paying reduced noms are eligible for Open as well as section prizes.

Event 1: Reduced or Full or Deposit

Event 2: Reduced or Full or Deposit

Payments using credit card
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Amount Paying: Card Number: Expiry Date

Credit Card Type: Visa Mastercard American Express

American Express Payments are subject to a 2% surcharge.

Thankyou you will be contacted if there are any problems with your payment.