I HEREBY APPLY FOR MEMBERSHIP IN THE PAINTED POST FIELD AND STREAM CLUB.
IF ACCEPTED, I PROMISE COMPLIANCE WITH ALL BY-LAWS AND REGULATIONS OF THE
CLUB.

SIGNATURE:____________________________      DATE :___________

FIRST: ______________________    M.I. ____    LAST: __________________________

ADDRESS:_______________________________________________________________

CITY:_____________________ STATE:________________ ZIP:_____________

PHONE:___________________ E-MAIL-,:___________________

SPONSOR:____________________________ DATE OF BIRTH:________/_______/____

MEMBERSHIP AND AFFILIATIONS

____NATIONAL RIFLE ASSOCIATION,   ____NY STATE RIFLE & PISTOL ASSOCIATION,    ___ GUN OWNERS TASK FORCE
____NATIONAL MUZZLE LOADING ASSOCIATION,    ____ INTERNATIONAL BENCH REST SHOOTERS

OTHERS:

INTERESTS

_____PISTOL      _____SKEET     _____BLACK POWDER     ____TRAP    _____SPORTING CLAYS

_____BENCHREST    _____RIFLE    _____CMP (High Power)    _____ARCHERY

OTHERS:

DUES AND ASSESSMENTS

REGULAR MEMBERSHIP $10 DUES + $25 ASSESSMENT = $35.00
RETIRED MEMBERSHIP $10 DUES+$15 ASSESSMENT =$25.00

KEY MEMBERSHIP INCLUDES A KEY TO THE INDOOR RANGE.
THIS CLASS OF MEMBERSHIP IS SUBJECT TO YOUR
SUCCESSFUL COMPLETION OF THE INDOOR RANGE
SAFETY COURSE. PLEASE PAY S20.00 AT SAFETY COURSE.

KEY MEMBERSHIP ~ REGULAR MEMBERSHIP + $20,00 (TO BE PAID AT SAFETY COURSE) = $55.00
RETIRED KEY MEMBERSHIP ~ RETIRED MEMBERSHIP + $20.00 (TO BE PAID AT SAFETY COURSE) = $45.00
TOTAL ENCLOSED ______________________________

MAIL FULL AMOUNT AND COMPLETED APPLICATION TO:

PAINTED POST FIELD & STREAM
PO BOX 325
CORNING, NY 14830

 FOR OFFICE USE ONLY

CARD # _______

DATE RECEIVED:__________KEY Y N

DATE SENT:____________________

1/06