SOUTH ST. PAUL ROD GUN CLUB

2010 Membership Form

 

Text Box: Name __________________________________________ Phone _________________________ Address ________________________________________ Date of Birth _____________________ City _____________________State______ ZIP ________ Email Address ____________________________________ Membership Type Membership Fee Educational Assessment TOTAL _____ Adult $ 75.00 $10 $ 85.00 _____ Adult & Spouse $100.00 $20 $120.00 _____ College $ 25.00 $10 $ 35.00 _____ Junior $ 10.00 $ 0 $ 10.00 _____ Lifetime Senior (SR #_______) -- $10 $ 10.00 Total: $_______ Total: $_______

 

Text Box: 1. Contact me when you need volunteer help at the Club. _____ Yes. _____ No. Occupation ____________________ 2. Have you ever been convicted of a felony? _____ Yes _____ No 3. Juniors Only. Hunter’s Safety Certification Number ________________________