P.O. BOX 696

MOLALLA, OR 97038

(503) 829-8843

NAME: _____________________________________________________ Date: ________________

ADDRESS: ________________________________________________

CITY/STATE/ZIP: ________________________________________

PHONE: _____________________ E-MAIL ADDRESS: _______________________________

OCCUPATION: __________________________________

EMPLOYER: ____________________________

What type of shooting most interests you? Rifle ______ Handgun ______ Shotgun ______

Black Powder _______ Other _________

NRA Membership # _____________ Expiration Date ____

Note: Please enclose a photocopy of your current NRA membership card or an address label from a recent American Rifleman, American Hunter, or American Guardian magazine to verify your NRA membership.

Explain, briefly, why you wish to be a member of the Molalla Rifle Club :

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

THE NRA PLEDGE

I certify that I am a citizen of good repute of the United States of America; that I am not a member of any organization or group having as its’ purpose or one of its’ purposes, the overthrow by force and violence of the government of the United States or any of its’ political subdivisions; that I have never been convicted of a crime of violence and that, if admitted to membership, I will fulfill the obligations of good sportsmanship and good citizenship.

______________________________________

Applicants Signature

Recommended by: __________________________________________

Initiation fee (New members only): $50.00

Annual Dues: $35.00

Amount Paid: $_____

Molalla Rifle Club assesses each member 12 hours of work bond or $50.00 per year prorated from date of membership. Work bond is to be completed or paid at the end of each year of membership at the rate of 1 hour of work for the club or $4.17 per month.

NOTICE: Membership Dues and Fees are subject to change upon approval by the membership of Molalla Rifle Club. Please call the phone number above to confirm current membership costs.

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Accepted: _______ Rejected: _____________ Reason for Rejection: _____________________________ _____________________________________________________________________________________

Secretary’s Signature: ______________________ Date: _______________________