NPGC Membership Application

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31454 312^th Place - P.O. Box 219 - Waukee, Iowa 50263
Phone (515)987-4415 - Fax (515)987-5094

APPLICATION FOR MEMBERSHIP

The undersigned, who hereafter shall be referred to as the "Purchaser", does hereby apply for membership in the New Pioneer Gun Club, hereafter referred to as the "Club". The Purchaser does enclose herewith the total of $175.00 in payment of the dues for 12 months in the amount of $125.00 and $50.00 for the purchase of one Participating Membership Certificate.

The Purchaser agrees that all payments made to the Club for the purchase of said certificate are nonrefundable and shall remain in the property of the Club.

The Club agrees to issue a Participating Membership Certificate to the Purchaser when the $50.00 has been paid. The Purchaser shall then be eligible to hold elective office and vote at meetings of the membership.

Date:	Name:
Occupation:	Signature:
	Street:
	City:	State:	Zip:
Sponsor:	Telephone:

Instructions: Print this page on your printer using your Internet browser's "print" option. Then fill it out and bring it to NPGC and submit it to the Manager.