Application for Membership

Online Application for Membership

Membership Open January 1st - August 31st

The Lowellvill Rod and Gun Club, Inc.

P.O. Box 1, Lowellville, OH 44436 Phone: 330-536-8143

(Actual physical address: 6225 Quarry Rd.) www.LowellvilleRodandGun.com

A $20.00 Non-Refundable Cash Deposit and a Copy of State Issued Photo ID Required with This Application.
Name

First NameLast Name
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Driver's License Number:
Issued in the State of:
Expiration:

MonthDayYear
Employer/Occupation:
NRA Member?
NRA Membership #
Concealed Carry Permit?
Permit State(s):
List Additional Permit States Here:
U.S. Citizen?
(If No, Student or Work Visa #)
Organizations/Affiliations/Interests:
THE LRGC RESERVES RIGHT TO PERFORM COMPLETE BACKGROUND CHECK UPON APPLICATION
Sponsor's Name
Sponsor's Badge #
Your reasons for joining The Lowellville Rod and Gun Club, Inc. (Please check all that apply

ArcheryFishingPistol ShootingRifle ShootingHuntingConservationEducation / InstructionTrap ShootingOther
Please list other here:
Pick a minimum of 3 areas of interest in which you would be willing to work for your required 20 hours.
Areas of Interest
Areas of Interest
Areas of Interest
Areas of Interest
Areas of Interest
Areas of Interest (Other)
List any special skills that may be beneficial to the Club. (Heavy equipment operator, landscaping, etc.)
I certify that the information in this application is true and complete to the best of my knowledge. I understan that if I am accepted, any false statements on this application may be considered sufficent cause for expulsion. Lowellville Rod and Gun Club reserves the right to use member's names and or likeness in all promotional materials.
Signature
DateTime
Completing this application does not guarantee membership into The Lowellville Rod & Gun Club, Inc.
PDF Version of this Membership Application (Click Here)
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