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    First Name:*

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    Home Phone:

    DOB:*

    Citizenship:*

    Sponsor (REQUIRED):*(Must be present at the club meeting)

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    NRA#:

    Are you legally able to purchase and own firearms in the state of Pennsylvania? YesNo

    Record of criminal convictions?YesNo

    Please explain (if applicable).

    How would you describe your gun handling experience? (Select One)

    Have you had any formal NRA (or other) firearm training?YesNo

    Are you interested in attending NRA certified classes? (Check all below of interest to you)First StepsBasic PistolPersonal ProtectionRange SafetyOfficer Instructor

    I am experienced in and will offer help to the Club in the following areas: (Please check all that apply)CarpentryMasonryElectricalPainting PlumbingPhone CallsComputerCorrespondence/Writing

    I hereby certify that:
    1. The information I have provided is true and correct.
    2. I am willing to participate in Club workdays.
    3. I am willing to abide by the final decision of the Club in regard to my membership in accordance with the Club’s application procedures and rules.

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