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 club 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.