Bridge River Rod and Gun Club Member Application Form

P l e a s e p r i n t

Name Address City Province Postal Code

Phone

E-Mail

Additional Members:
Age if Under 19 Age if Under 19 Age if under 19

Name Name Name Membership Fees:

Adults (Over 19) 40.00 Children 19 and Under 15.00 (Membership runs from January 1st to December 31st) 3 Year Membership, Adults , Children (Expires December 31, 2013) Range Key: 120.00 45.00 Amount enclosed: 10.00 $________________

Owners of restricted firearms please provide one of the following, as required by firearms act:

ATT# (Authorization to Transport) Please make cheques payable to: Bridge River Rod and Gun Club General Delivery Gold Bridge, BC V0K 1P0

Date of Birth