TRI - STATES ROD & GUN CLUB Inc
266 NORTH ORANGE ST. P.O. Box 801. Port Jervis, NY. 12771-0801
Affilated with:
Orange Co. & Sullivan Co. Federation of Sportsman's Club
New York State Conservation Council
National Rifle Association
New York State Rifle & Pistol Association
Port Jervis, N.Y........................................................................... 2016...
I Hereby Apply for Membership in this Association and Enclose:
$130.00 Senior
Initiation fee    $100.00
Annual dues    $30.00
$5.00 Junior              for 2016... Dues.
No Initiation Fee for Ages under 16 yrs.
Annual Dues are due January 1 ST
Name
Address
City
Date of Birth
State
Zip
NRA No:
Sponsored By Current Member
Current Sponsor's Phone Number
I.D. #
To be Voted on by the the Board of Directors and Members in Good Standing at the Next Club Meeting.
Please mail Form and Check or Money Order to
Tri States Rod and Gun Club
P.O. Box 801 Port Jervis N.Y. 12771
Attention Membership Secretary
Phone Number
E-Mail
Please allow 2 weeks from when we receive your payment for Membership Card