FIRST NAME M..I.. LAST NAME

ADDRESS APT

CITY STATE ZIP + 4

PHONE #     EMAIL

BIRTH DATE ARE YOU MEMBER OF THE NRA? USA SHOOTING ?

MEMBERSHIP CATEGORIES

 LIFE ___$300.00       ANNUAL___$20.00       JUNIOR___$7.5O    

                         6 YEAR MEMBERSHIP _____$100.00     

PAYMENT METHOD

       VISA      MASTERCARD        DISCOVER CARD      AMERICAN EXPRESS   

 CARD NUMBER   EXPIRATION DATE (MO/YR)

SECURITY CODE Generally 3 # on back of card

FSSA NEWSPAPER -MIXED CALIBERS

  MAILED TO YOUR HOME (4 TIMES A YEAR)              DOWNLOADED FROM FSSA WEB SITE

SPONSORED BY (Optional)