Pine City Sportsmen’s Club
PO Box 110, 187 Mt. View Dr., Pine City, NY 14871
Membership and Renewal Application
http://www.pinecitysportsmensclub.com
http://www.facebook.com/Pine City Sportsmen’s Club
NAME ______Date of Birth ______
Street Address ______
City______State ______Zip Code ______
Phone (Including Area Code) ______
E-Mail Address: ______(will not be released)
Spouse and Kids names ______
Make, Model and Plate number on all of your vehicles ______
______
Please check Appropriate Box {Make Check Payable To: Pine City Sportsmen’s Club}
( ) New Member - $75+ $25 Initiation Fee + $10 Key fob TOTAL $110.00
( ) Renewal (If paid prior to January 1) - $75.00 TOTAL $75.00
( ) Renewal (After Jan. 1) - $75.00 + $25.00 late fee TOTAL $100.00
Signature: ______Date: ______
By signing this application you acknowledge that you have read the club safety and usage rules (which can be found on the club website and are also mailed with the annual renewal notice). If you membership application or waiver is not signed, your check will be returned with your application for signature.
Anyone who violates any of the safety and usage rules, by laws, or constitution may have their membership and/or range privileges suspended or revoked.
Questions can be directed to -
Membership Chair Melissa Cook Lohman – email address:
Submit membership paperwork by mail to the address at the top of this application OR you can drop your membership off at the drop box to the left of the door at the clubhouse OR bring to a monthly PCSC meeting.
Meetings are the last Monday of the month at 6:30pm – check the website for the meeting dates – May, November, and December sometimes change due to the Holidays.
Are you a member of the NRA _____ Yes _____ No
NOTE: If you join the NRA at the monthly meeting, you can join for $25 – a significant savings.
Are you a member of the NYSR&PA _____Yes _____ No
Membership Year Runs from January 1 to December 31 – each year.