Lawrence
Rod & Gun Club, Inc.
Application
for Membership
(Please Print Clearly)
Name:(First)__________________________(MI)_____(Last)____________________________________
Address:_________________________________________________________________________________
City:
Phone#: (_______)_______________________ Date
of Birth: (mm/dd/yy)_______________________
Occupation: _________________________ Auto
Registration #:
Email
Address:
______________________________ @
_________________________________________
Are
You a Member of the…………. N.R.A.? (y/n)_______ G.O.A.L.?
(y/n)________
Are
You a
Club Member Sponsor's Name:
_________________________________________________
..... Or List 3 References .....
Name:
____________________________________ Phone #: (______)_________________
Name:
____________________________________ Phone #: (______)_________________
Name:
____________________________________ Phone #: (______)_________________
Senior
members: 18 years of age or older $125.00
(Includes Initiation Fee of $50.00 and
Current Year Membership Dues $75.00)
Junior
members: ............................. $25.00
Membership Dues May Be Paid by:
Cash, Check or Money Order
I
understand that I will not receive a membership card and key until I have been
given an orientation presentation at which time I will also be given a copy of
the club's By-Laws and Range Rules. It will be my responsibility to familiarize
myself with the material contained herein.
Liability
No
member of this club shall be held liable for any action or accident occurring
on the club’s property. There is no liability, expressed or implied, to any
member, and by signing this membership application and accepting membership
into the club, all members acknowledge that the use of the club’s facilities is
at his/her’s own risk.
Signature:
________________________________________________ Date:
_____________________
NOTE:
APPLICATION FOR MEMBERSHIP MUST BE
PRESENTED IN PERSON DURING A REGULAR CLUB MEETING.
(Form
Revised: May 2005)