Lower Providence Rod & Gun Club Membership Application


Please Note: This is a membership APPLICATION.
Successfully completing the application and payment is just the first step to becoming a member.
You need to attend two membership meetings, orientation, and a work party before you will become a full member.
You can not use the club until you have completed all of these requirements and receive a full membership card.
Applicant Information
First Name:*
Middle Initial:
Last Name:*
Mailing Address Information
Address Line 1:*
Address Line 2:
City:*
State:*
Zip:*-
Home/Primary Phone:*
Work Phone:
Newsletter Preference
Email Address:*
Birth Date:*(MM/DD/YYYY)
Drivers License Number:*
Occupation:
Please check if Retired or Disabled

Club Survey
Which activities are you interested in at the club:
Archery
Pistol
Rifle
Trap
Are you a NRA member?
Yes No
NRA Member Number
Check here if you hold NRA instructor certifications
Sponsor Information
Sponsor Name:
All applicants must be sponsored by a current club member.
If you do not have a sponsor yet you can leave this blank.
Note that you will have to find one in order to become a full member.

Membership Price
Initiation Fee: $150
Dues: $200
Key Card: $10

Additional Family more info
Spouse/Partner Member: $30
Enhanced Spouse/Partner Member: $66
     Spouse/Partner Name:
Junior Member(s) ($20 each)
Name:
Name:
Name:

2018 Balance Due: $360.00
















Please complete all required fields