Membership Application Form

Washington Hollow Rod and Gun Club Membership Application

To apply for membership please complete all questions.
Sponsor Name

First NameLast Name
Applicant Name

First NameLast Name
E-mail
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number
Cellular Number
Emergency Contact 1

Full NamePhone Number
Emergency Contact 2

Full NamePhone Number
NRA Member Number
Type of shooter

PistolRifleShotgun
Employer

CompanyPhone Number
Employer Address*

Street Address

Street Address Line 2

CityState / Province

Years EmployedCountry
Below please list 3 references who have known you for at least 5 years.
Reference 1

Full NamePhone Number
Reference 1 Email
example@example.com
Reference 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2

Full NamePhone Number
Reference 2 Email
example@example.com
Reference 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3

Full NamePhone Number
Reference 3 Email
example@example.com
Reference 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please update a portrait orientated photo of yourself

Cancelof
I hereby apply for membership in the Washington Hollow Rod & Gun Club, Inc. and agree that if I am voted into membership, I will abide by all of its regulations & By-laws. I further certify that all the forgoing answers are true and that any false statements result in the forfeiture of membership and fees.
Signature

Clear
Signature Date

MonthDayYear
Date
Initiation is $200.00 Full membership $200.00 *Prices subject to change
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Washington Hollow Rod and Gun Club Membership Application

Below please list 3 references who have known you for at least 5 years.

Initiation is $200.00 Full membership $200.00 *Prices subject to change