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)
__ Trap  __ Skeet __ 5-Stand __ Indoor Pistol
__ Indoor Rifle __ Fishing __ Archery
__ Conservation __ NRA Member NRA No.___________________