MEMBERSHIP APPLICATION
___________________________________________
Name

___________________________________________
Address

___________________________________________
Telephone

___________________________________________
           Email              
   In the last 5 years, have you been convicted of Game or Fish Law violation, in Pennsylvania?  _______          _______
                                                                                                                                                             NO                 YES
   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

   AS A CLUB MEMBER, I WILL HELP WITH CLUBS PROJECTS._______       _______
                                                                                                                                                         YES                         NO

   ________________________________________________
                       Sponsor Member's Signature

    ________________________________________________                       _________________
                            Applicant's Signature                                                              Date
**Dues of $20.00 must accompany this application**
($6.00 for Jr. members)
Just print this page then fill this application out and mail it to the address at the top of this page.