New Annual Range Pass

Your privacy is important to us. SSAA Mount Isa Branch (Q13) collects personal information to manage the branch and for administrative purposes. We do not store your data on the web site.  We do not share your personal information with third parties except as required by law. You may request access to the information we hold about you at any time. If you are not comfortable with supplying your information online please contact us via the Contact Us link on the home page

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Please Note

You must be a member of SSAA Queensland to join the Mount Isa Branch: https://ssaaqld.org.au/

This access  cannot be used as your genuine reason for a rifle licence (must be SSAA Queensland Membership) https://ssaaqld.org.au/

Name *

First

Last

Date of Birth

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Email *

Phone

Address

Address Line 1

City

State / Province / Region

Postal Code

SSAA National Number

SSAA Branch (Q??)

Rifle Licence Number (if held)

Expiry Date

Cat H Licence Number (if held)

Expiry Date of Cat H

Do you want to add family (Family Pass)?

• No
• Yes

Family Members

Name

Date of Birth

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Rifle Licence Number (if Held)

Rifle Licence Expiry

Cat H Licence Number (if held)

Cat H Expiry

Add Remove

Checkboxes *

• I have read and agreed to the ADF indemnity
• I have read and understood the conditions of membership

ADF Indemnity

Conditions of Membership

Type of Annual Pass / Cat H Admin Fee

• Adult AB (Rifle) – $85.00
• Adult AB and H (Rifle + Pistol) – $120.00
• Pension – $50.00
• Pistol Only (must be AB member) – $35.00
• Family (AB) – $110.00
• Family (AB)+1H – $145.00
• Family (AB)+2H – $180.00

Total

$0.00

add SSAA /

Please prove you are Human *

What is 7+7?

Payment Options *

• PayPal (includes Credit Card)
• Bank Transfer

Bank Details

Acc: SSAA MTISA

BSB: 064815

ACC: 10158692

PayPal Commerce *

PayPal CheckoutCredit Card

Card Number

Expiration Date

Security Code

Card Holder Name

Submit