NAME: __________________________________________________________________

SASS ALIAS: _____________________________________________________________

SASS NO: _______________________________ NRA NO: _______________________

SASS LIFE MEMBER: Yes _____ No _____ NRA LIFE MEMBER: Yes _____ No _____

ADDRESS: ______________________________________________________________

CITY: ________________________ STATE: ___________ ZIP CODE: ______________

EMAIL ADDRESS: _______________________________________________________

TELEPHONE: (H) _________________________ (W) ___________________________

OCCUPATION: __________________________________________________________

National Rifle Association Pledge: I certify that I am a citizen of the United States of America and that I am
not a member of any organization or group which has as any of its programs the attempt to overthrow the
government of the United States or any of its political sub-divisions by force or violence, and if admitted to
membership I will faithfully endeavor to fulfill the obligations of good sportsmanship and good citizenship.

SIGNATURE __________________________________________ DATE _____________

Please list any particular talents, interests or abilities you have that may be of interest to The
River Junction Shootist Society.

________________________________________________________________________

With which of the following committees would you like to work?

Range Officer _________	Membership _________
Target/Prop Construction _________	Shooting Stage Design _________
Newsletter _________	Administration _________
Match Results _________

Dues are $35/year per member. Family rate is $55 andincludes family members residing at the same address.
Make check payable to River Junction Shootist Society
and send with completed application to the following address:

RIVER JUNCTION SHOOTIST SOCIETY
P.O. BOX 185
DONEGAL, PA 15628