Date___________________ Name_______________________________________ Address____________________________ City_________________________________ State____________________ Zip_______________ Age_________ Occupation____________________________ Phone Number___________ Email Address____________________________________________ Have you ever been convicted of a felony, crime, or misdemeanor?__________________________________________ If so, state place, date and nature of crime__________________________________________________________ Have you ever had a concealed weapon permit cancelled?________ If so why?__________________________________ Applicant's Signature _______________________________________ One Member's Signature__________________________________________ Approved by_______________________ Chm of Membership Committee ========================================================= COST OF MEMBERSHIP - JUNIORS (age 12 to 17) $15 & $1 INITIATION FEE - REGULAR (age 18-64) $70 & $20 INITIATION FEE - SENIORS (age 65 AND OVER) $35 & $20 INITIATION FEE - KEYS ARE AVAILABLE TO REGULAR & SENIOR MEMBERS $2 YOU MUST ATTEND A MEETING TO APPLY AND BE ACCEPTED INTO MEMBERSHIP. AT WHICH TIME YOU WILL GO OVER THE RULES BEFORE APPLICATION CAN BE APPROVED. DUES ARE DUE AT THAT TIME, MEMBERSHIP CARD AND KEY WILL BE ISSUED. MEETINGS ARE HELD THE 1ST WEDNESDAY OF THE MONTH. Received of_______________________________ Date_____________ Subject to the approval of the Association. If not approved this money will be returned. $_________________ Check #__________ Cash________ (Mark One)____Regular Member ____Senior Member ____Junior Member If you do not receive your official membership card within 30 days, notify your secretary By_________________________________________ ______Card sent _______Key Provided Please visit our website: www.pineriversportsmans.com for updated information on club activities, calendars, pictures and upcoming events.