Old #4 Rod, Gun & Snowmobile Club Inc.

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OLD 4 R,G,SM CLUB

       Membership Application 2017-2018

 Check one   New___ Renewal___ Life member___
                                                                    DOB_____
Name:                                           

Mailing address:                          

City:

State:           Zip Code:                  Phone#    

E-mail:                                          NRA member  Y / N
                                                      NRA ID#________
Membership Option (Check One)
Range:____                     $40.00
Snowmobile:____           $35.00     DOB required for NHSA
Range/Snow____           $50.00
Additional Donation__________
                     Total Paid:_______
Life Membership requirements: Must be 68 Yrs./over
and been a club member for 5 consecutive years.
All memberships are considered family memberships
Family includes spouse and children under 18 only.
Family Name:________________
            Name:________________   Age:___
            Name:________________   Age:___
            Name:________________   Age:___

Would you be interested in helping with Range:____
                                                                    Trails:____
                                                         Fundraising:____
                                      
Membership year runs from July 1st to June 30th