Membership Application
Membership Application
Plattsburgh Rod & Gun Club
PO Box 616
Plattsburgh, NY 12901


Date: ______________________


Last Name_________________________________   First _________________________


Address_____________________________________________


City____________________   State_____   Zip__________


Telephone  (______)______________________

E-mail_________________________


__Membership - $20

__ Six Year Membership - $100

__Jr. Membership - $15 (14-17 yr.)

__Family - $30  List name(s), relationship, and (date of birth of Jr. Members)


Total Payment Enclosed:  $______________

(Check payable to the Plattsburgh Rod & Gun Club, Inc.)

__ Trap   __ Skeet   __ 5-Stand   __ Indoor Pistol

__ Indoor Rifle   __ Fishing   __ Archery

__ Conservation     __ NRA Member   NRA No.___________________