APPLICATION FOR MEMBERSHIP

Mail To: P.O. Box 222 Carthage, IL 62321

NOTE: All applications submitted should be as complete as possible and must have "Character Reference" or "Sponsor" sections complete, and include a Cashiers check, money order, or personal check for the appropriate amount, in order to qualify for consideration by this organization.

 

NAME        __________________________________________________________________________________________

 

ADDRESS   __________________________________________________________________________________________

                           

CITY           _______________________________________________ STATE   ___________   ZIP CODE   ____________    

 

DATE of BIRTH   _____________________________

 

HOME PHONE   (           )-_________-____________

 

OCCUPATION    ______________________________

 

EMPLOYER       ______________________________

 

How many years have you been handling  firearms? ______________________________________________________________

 

Have you completed a FIREARM SAFETY or HUNTER EDUCATION course?  YES   NO

 

FOID# _____________________________________   Are you a U.S. citizen?   _______________________________________

 

National Rifle Association? YES   NO   Membership #________________________ Expiration date_______________________

 

Any other conservation, hunting shooting clubs, groups or organizations? ____________________________________________

 

________________________________________________________________________________________________________

 

________________________________________________________________________________________________________

 

Do you hold any instructor or shooting organization classifications? ________________________________________________

________________________________________________________________________________________________________

 

Family members interested in using the range.   ________________________________________________________________

 

________________________________________________________________________________________________________

 

In case of Emergency contact:

 

Name   _______________________________________   Phone #   ________________________________________________

 

Address   _______________________________________________________________________________________________

 

Relationship _____________________________________________________________________________________________

 

OR

 

Name    _____________________________________   Phone #   _________________________________________________

 

Address   _______________________________________________________________________________________________

 

Relationship   ____________________________________________________________________________________________

 

AREAS OF INTEREST: Check all that apply

 

_____ Handgun                    ______ Rimfire Rifle                    ______ Benchrest Rifle                    _____ High Power Rifle

 

_____ Black Powder            ______ Archery                           ______ Trap                                   _____ Skeet

 

_____ Sporting Clays           ______ Hunting (small game)       ______ Hunting (large game)           _____ Conservation

 

_____ Hunter Saftey Education                                              ______ Firearm Safety Education

 

 

 

Applicant's Signature: ____________________________________________ Date ____________________________________

 

Note: Annual dues must be paid by June 1 of each year OR the initiation fee will be charged

 

Mail the completed form to the address on the reverse side of the form.