APPLICATION FOR MEMBERSHIP
First name:   Middle name:   Last name:  
Nickname:  
Home telephone:
Area code:  
Telephone:   		Work telephone:
Area code:  
Telephone:  
E-mail address: 
Mailing Address
Street:  
City:   State:   Zip code:  
Date of birth (mm/dd/yyyy):  City of birth: State of birth:
NRA member number:
  
Have you ever been a member of a shooting club anywhere?   Yes     No

Name of club:  
Areas of interest?   Rifle   Pistol   Trap   Archery   Fishing  
Have you ever been convicted of a felony?   Yes     No

Occupation:  
What work skills or equipment can you contribute to the club facilities and building
maintenance program?


Give some examples of abilities or skills you possess that should be considered
in your selection by the membership committee.


Please add any other comments or notes you wish regarding information on this form.
Please enter the name of the CRGC member sponsoring your application.

I understand that a false answer to any of the foregoing will cause me to be denied
admission, or to have my membership revoked after admission.   I certify that all of
the information contained in this application is complete and correct to the best of my
belief and knowledge.

APPLICANT'S SIGNATURE: __________________________________________

CRGC MEMBER SPONSOR SIGNATURE: _______________________________

Send signed application to the following address,
and click on submit button to send electronic form.

CANBY ROD & GUN CLUB
PO BOX 311
CANBY, OREGON  97013
ATTN:  MEMBERSHIP COMMITTEE