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Application for
Membership
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Annual Fee: $ 5.00 Youth (0-16
years)
If sending application
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Are you applying for? Disabled Membership ______ Able Bodied membership ______ Corporate Membership ______ Youth Membership ____ Name ___________________________________________________________ Date of Birth _____________________ Address __________________________________________ Email ____________________@______________________ City _______________________ State ____________________________ Zip Code (include last four) _______-_____ Home Phone (____)_________________ Business Phone (_____)__________________ Fax (____)___________________ Cell Phone (_____) _________________ Website address: http:________________________________________________ Please Indicate Where Applicable: Type of Disability _____________________________________________________________________How Long Have You Been Disabled? ___________________________________________________________________ Currently Shooting (Please Circle One) LONG BOW RECURVE COMPOUND CROSSBOW NONE Type of Business You’re Now In _______________________________________________________________________ Are You A U.S. Veteran? If Yes, Please Indicate Branch & Wars Served In ______________________________________ Are You A Member of Pope & Young Club? Yes ________ No ________ Membership # ___________________________ Are You A Member of National Rifle Association? Yes ______ No ______ Membership # _________________________ Are You A Member of Safari Club International? Yes _______ No _______ Membership # _________________________ What Assistance Do You Need From PCBA? ______________________________________________________________ ___________________________________________________________________________________________________ In What Ways Would You Like To Assist PCBA? ___________________________________________________________ ___________________________________________________________________________________________________ Signature ________________________________ Date ____________________PARENT/GUARDIAN MUST SIGN BELOW IF UNDER 18 YEARS OF AGEI am the parent/guardian of the above signed minor (under 18 years of age) and agree to his or her membership in the PCBA.
Signature
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Join Us or Recruit a New Member!!
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