Ramapough Sportsmen Association

                                                       P.O. Box 366 

                                                Nanuet, New York 10954

                                                Membership Application

Please Print or Type:

Name     :_________________________            Telephone    :___________________

Address :_________________________            Date of Birth :___________________

City       : _________________________            Employer      :___________________

State     : ______________ Zip:________            Occupation   :___________________

Email Address: _____________________

Do You Have a Pistol License:  Yes___  No___   License # ____________ Issued __/__/__

List other memberships                                        Indicate interests by preference

1. ___________________________________       Pistol  ___   Rifle ___

2. ___________________________________       Skeet ___  

3. ___________________________________       Black Powder ___

Have you ever been refused any club membership ?                 Yes ___   No ___

Have you ever been convicted of a conservation violation ?      Yes ___   No ___

Have you ever been convicted of a felony or a misdemeanor ?  Yes ___   No ___

Explain any "Yes" answers to the above questions on the back of this form.

Are you prepared to actively participate in this organization's activities, maintenance, and / or run for club office; all of which require time and effort on your part ?  Yes ___   No ___

If your answer is "No", please explain here: _____________________________________________

______________________________________________________________________________

If your answer is "Yes", please let us know what areas you are prepared to participate in and how you can assist the club.________________________________________________________________

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Club Members Known to me:                               Recommended by:

1. Name  ___________________ Tel# _______  1. Name  ___________________ Tel# _______

2. Name  ___________________ Tel# _______  2. Name  ___________________ Tel# _______

I understand that any false statement contained herein will be cause for dismissal from this club and authorization is hereby given for the membership committee to conduct any investigation deemed necessary to render their recommendation on my application.

Applicant's Signature _________________________   Date:___________

NRA Membership is Mandatory   NRA ID# ___________

    Dues for the first 10 consecutive years of  non- vested membership are $170.00 per year.

Dues are reduced in subsequent years to 120.00 per year as a vested member.

    You are required to attend one of the two consecutive monthly regular meetings, at which time your application will be read. 

    It is mandatory that you attend a range safety / orientation meeting before you receive your club credentials and identification.

    It is mandatory that a new member be required to become a NRA Range Safety Officer within the first year of membership.

    Membership runs from January 1st to December 31st of each year.  Members who join during the year will have their dues pro-rated. Dues are payable when the dues notice is received.

    No facilities can be used without a current colored identification card.

Dues are adjusted annually and may be changed as needed.

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For Office Use Only

Date Received: __________                        First Reading :      __________

Check No.______  Amount: $_______        Second Reading: __________

Date of Range Safety Orientation: _________