Seitzland Rifle Club Application

Seitzland Rifle Club, Inc.
P.O. Box 232
New Freedom, PA 17349

Application is for a two year conditional membership and requires 8 hours of volunteer work each of the two years for renewal and full membership.
Name*

First NameLast Name
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date*

MonthDayYear
Age*
Phone Number*
Format: (000) 000-0000.
Occupation*
Email*
example@example.com
Give two character references:
Name - Reference #1*
Address - Reference #1

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number - Reference #1*
Format: (000) 000-0000.
Email - Reference #1*
example@example.com
Name - Reference #2*
Address - Reference #2

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number - Reference #2*
Format: (000) 000-0000.
Email - Reference #2*
example@example.com
Signature of MEMBER in good standing (SPONSER) who suggests your becoming a member of this organization:
Print Sponsor Name*
Signature of Sponsor

Clear
If available to sign - not required
Phone Number of Sponsor*
Format: (000) 000-0000.
Full MembershipSpouse MembershipJunior Member
YesNo
If so, where?
YesNo
If so, where?
High Power RiflePistol SilhouetteSmall Bore Rifle
Hobbies and interest*
Skills that may help our club*
YesNo
YesNo
YesNo
As of January 1st, 2023, Seitzland Rifle Club now requires membership in at least one of the following organizations:
- National Rifle Association
- Firearms Policy Coalition
- Gun Owner's of America
Check the boxes of the organizations that your are a member of or have applied at and the expiration date of your membership (if applicable). Also, please provide the membership number, if the organization provided one.
National Rifle AssociationFirearms Policy CoaltionGun Owners of AmericaNone of the above - I refuse to join a political activist group!
NRA Member #
NRA Expiration Date

MonthDayYear
Leave blank if life member
FPC Member #
FPC Expiration Date

MonthDayYear
Leave blank if life member
GOA Member #
GOA Expiration Date

MonthDayYear
Leave blank if life member
NRAFPCGOA
Initiation Fee
Membership Fee
$100 - individual // $125 - family // $25 - junior
Membership fee includes insurance coverage. Total amount to be paid upon acceptance of this application.*
Signature - I understand that my membership will be terminated if I do not abide by all club rules, regulations and by-laws.*

Clear
AcceptsRejects this application. Date
Date

MonthDayYear
Date
President
Membership Secretary
Date of interview

MonthDayYear
Date
Date dues paid

MonthDayYear
Date
Date of orientation

MonthDayYear
Date
Should be Empty: