Pitcairn Monroeville Sportsmen's Club
Membership Application

Please print or type information clearly

MEMBERSHIP CARD #	Date:
Last Name:	JR/SR:
First Name:	Middle Initial:
Email:	Phone:

ADDRESS:	APT #
CITY:	STATE:		ZIP:
Date of Birth:	Sex: M / F		Married: Y / N
Spouse Name (if applying for spousal membership):
Child name (if applying for junior membership):
Child name (if applying for junior membership):
Child name (if applying for junior membership):
Occupation:		Employer:
US Citizen:		Member of NRA:

INTERESTS (Please circle all that apply):

ARCHERY

PISTOL

RIFLE

CMP/DCM

TRAP

HUNTING

IPSC/USPSA

BB GUN

SKEET

If joining by mail, please include a passport size photo of yourself. Mail photo, application, and payment to:

PMSC Membership
PO Box 24512
Pittsburgh, PA 15234

412-327-4932
pmscmembership@gmail.com

If you will be joining the club at a membership meeting, held the first Wednesday of every month at 7PM, your photograph will be taken at that time. Please bring some form of Identification.

Current Fees are due with application. Please make checks payable to PMSC.

$40.00 (Initiation Fee) Plus  $60.00 Dues

$15.00 (Spousal) $5.00 Junior (under 18)

Dues run from January 1 to December 31

Payment made by: Check#________     Amount:________    Cash _______

This organization is governed by strict By-laws and regulations. Any violation of said rules, regulations or falsifications of this application can cause immediate expulsion from the Pitcairn-Monroeville Sportsman’s Club Inc. By signing this application, the applicant pledges to obey all said laws and rules, and will not support anti-gun legislation: belong to, or support any anti-hunting, fishing, trapping, or animal rights activists groups.

I understand that I will be on probation for one (1) year if a new member.

Proposed Member's Signature _____________________________________________________________________________

Questions? Contact    kebreb@verizon.net