Eagle Valley Muzzleloaders

MEMBERSHIP        APPLICATION

        DATE_{______________}

                _{NAME________________________ HANDLE________________________}

                _{ADDRESS ________________________________________AGE_________}

                _{CITY ___________________________ STATE ________ ZIP ____________}

                _{HOME PHONE___________________ WORK PHONE__________________}

                _{MEMBERSHIP  NRA #__________         MEMBERSHIP  NMLRA  #_______} 

                _{FAMILY________ SINGLE _________ If this is a family membership list all names below}

                                NAME                                AGE         RELATIONSHIP

            _____________________________   ______  ___________________

            _____________________________   ______  ___________________

            _____________________________   ______  ___________________

             _____________________________   ______  ___________________

            _____________________________   ______  ___________________

                        ANNUAL MEMBERSHIP DUES   24.00 family   ( includes children under 18 )

                            ( May 1 thru April 30 )                 18.00 Single  

                                first year dues will be prorated by monthly increments

                                    MAKE CHECKS PAYABLE  TO :    EAGLE VALLEY MUZZLELOADERS

                                                                                                   P.O. BOX 3444 , CARSON  CITY,  NV. 89702

                                        TELEPHONE  ( 775 ) 887-1221      OR       ( 775 ) 883-7736