WESTERN PA 30 Cal League, Inc.

Membership Form

Payable to: Western Pa Cal. 30 League

% Jason Mohr

3009 Albine Dr.

Glenshaw, Pa. 15116

412-492-8073

jsnmhr@yahoo.com

 

MEM. #________________(For Renewals) Due Date: March 31, 2004

 NAME : (LAST) ______________________ (FIRST) _________________(MI)_______

 STREET ADDRESS:______________________________________________________________

 CITY: _____________________________ STATE: __________ ZIPCODE:__________

 PHONE #: ( ) ______________________ DATE OF BIRTH: ___________________

 NRA ID#:* _________________________ NRA CLASSIFICATION:*______________

 RIFLE TYPE: (MR, CSR, ETC.) *__________________ JUNIOR (Y OR N)_________

 EMAIL ADDRESS: **

________________________________________________________________________

MEMBERSHIP FEES: ADULTS: $25.00 JUNIORS: $15.00

* Optional Info - Not Required for F-Class Shooters

** Match Scores and League Info ONLY will be sent.