MEMBERSHIP APPLICATION
________________________________________ _______ ______________________________________
Print First Name MI Last Name
_________________________________________ ____________________________________________
Mailing Address: Street or PO Box (Mailing) City, State, Zip Code
__________-______________-_______________ ______________________
Telephone Birth Year Only
__________________________________________________@________________________________
Print Email Address
In the last 5 years, have you been convicted of Game or Fish Law violation, in Pennsylvania? _______ _______
YES NO
If yes, please explain.___________________________________________________________________________________
_____________________________________________________________________________________________________
Do you swear to uphold all Game and Fish Laws? _______ _______
YES NO
Do you understand that as a member, if convicted of a Game or Fish Law violation, your membership may be
revoked? _______ _______
YES NO
I have read and understand the Rifle and Pistol Range Rules and Regulations and agree to abide by them, ______YES ______NO
(Click HERE to read Range Rules and Regulations)
AS A CLUB MEMBER, YOU ARE REQUIRED TO ATTEND AT LEAST ONE MEETING OR HELP WITH AT LEAST ONE CLUB PROJECT PER YEAR, DO YOU AGREE WITH THESE TERMS? _______ _______
YES NO
________________________________________________ __________________________________________
Print Sponsor's Name Sponsor Member's Signature
________________________________________________ ______ /_______/_________
Applicant's Signature Date
**Dues of $25.00 must accompany this application**
($6.00 for Jr. members age 12 to 15)
($5.00 for Active Law Enforcements)
Just print this page then fill this application out and mail it to the address at the top of this page.
All information is kept confidential.
revision 7/2015
