CLUB NAME

NRA CLUB # EXPIRATION DATE

CLUB WEBSITE

CLUB INFORMATION

PHYSICAL ADDRESS CITY   STATE ZIP + 4

PHONE #  FAX EMAIL

MAILING ADDRESS CITY   STATE ZIP + 4

METHOD OF PAYMENT OF DUES

 CLUB DUES_______________________ $50.00

 PAYMENT METHOD

  VISA     MASTERCARD    DISCOVER CARD      AMERICAN EXPRESS 

  CARD NUMBER   EXPIRATION DATE (MO/YR)

FSSA NEWSPAPER -MIXED CALIBERS

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

SPONSORED BY (Optional)