Application for Membership
in the
Rochester Junior Rifle Club, Inc.
R.R.C.
P.O. Box 20617
Rochester, New York 14602-0617
716 292-1830

Date _____________
 
I hereby make application for membership in the Rochester Rifle Club, Inc., and if accepted, I promise compliance with all bylaws and regulations of the club.
 
JUNIOR CLUB MEMBERSHIP - Initiation 
 [from another NRA club]$ 5.00
For calendar year 200__Annual dues$ 5.00
 Basic Safety Course$15.00
Transfer from Club1st Year Dues$ 1.00
 Explorer Scout$ 7.00
____________________  
 Total $_______
Basic Safety Course Completed
Week No.         1         2         3         4         5         6         7
  
New applications must be mailed to the above address or given to the Junior instructor. Do not send check or money with this application. All applicants must complete a 14 hour Basic Safety Course before joining the Junior Club or Explorer Post.
  
Youth Name ______________________________________________________
First                                 Mi                                 Last
  
Address______________________________________________________
  
City_______________________________ Zip __________ - _______

Please furnish the following infromation.
Home phone_____________________SS No_____________________
Date of birth____/_____/_____School_____________________
Troop No ______ Post No ______Council_____________________
NRA Membership Number________________________________________
NYSR&PA Number________________________________________
Junior members are urged to be members of the NRA and NYSR&PA
 
PARENT APPROVAL_______________________Date__________
CLUB APPROVAL BY_______________________Date__________