MEMBERSHIP APPLICATION

Fill out then print the form. Please sign, date then mail in with payment.

MEMBER NAME
DATE: New Membership Renewal
Primary Member: D.O.B: $75.00
Family Member: D.O.B: $15.00
Family Member: D.O.B: $15.00
Family Member: D.O.B: $15.00
Family Member: D.O.B: $15.00
Card Nos: Total Amount Paid:
Family Member includes spouse and children under 18 years of age still living at home.
CONTACT INFORMATION
Home Phone No.:

Work Phone No.:

Address 1:

Address 2:

Town/City:

Postal Code:

 Email:

Firearms Licence No.:

I have read, understood, and agree to abide by the Range Safety Rules and Protocols. I understand that failure to comply shall be grounds for revocation of membership without refund of dues.

Name/Date: