Clairton Sportsmen’s Club        Number____

Application for Junior Membership

Please print clearly

Name______________________________________

Age____________ Date of Birth______________

Address_______________________________________________

______________________________________________________

Phone________________________________-

Email_____________________________  

Dues $20 (no inititation)

Areas of interest ….. circle as many as you wish

Pistol       100yd pistol     action pistol      rifle      skeet     trap     archery        3-d archery

________________________________________________________________________

Total received this application _____$20__________Cash □  Check  □  #__________________

I am a citizen of the United States                  Yes □                   No □

Have you ever been convicted of a felony        Yes □                  No □

__________________________________

Signature of Applicant (Please show Identification)

Falsification of information will result in termination of Membership

__________________________________________                       _______________________________________                                                           

Signature of member in good standing            Signature of member in good standing

Application taken by___________________________ Date_______________________