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