SMLPSA Membership Application Form

SMLPSA Membership Application Form

October 2017- October 2018

(Effective February 1, 2018)

($150.00 Initiation Fee is waived for the first 500 Club Members)

Date:______

Primary Members Name:______

Associate (Family) Members Name:______

Associate (Family) Members Name:______

Associate (Family) Members Name:______

Mailing Address:______

Phone Number:______

Emergency Contact & Number:______

Email Address:______

NRA Membership #”s (Required for Primary Member only)

______

Please choose the type of membership each family member is applying for, and put that person’s name next to the choice on page 2 of this form:

Lifetime Membership $210/person:______

($210 initial payment (includes a Range Discount Card good for ten one-hour range sessions), then $10 per year for the next five years for renewal. After that, no renewal fees or other fees apply, and can buy Range Discount Cards at any time. Life Memberships can be transferred to surviving spouse within one year of passing. A primary member)

Discounted Regular Range User $110/person: ______

(Includes a Range Discount Card good for ten one-hour range sessions. These cards can be purchased any time after first card is used up. A primary member)

Full Price Occasional Range User $60/person: ______

(Will pay $10.00 per hour when using the range. Range discount card is not available to this level of membership. A primary member)

Associate Membership Range User $20/person:

(Will pay $10.00 per hour when using range. Range discount card is not available to this level of membership. Not a primary Member)

______

______

(Limited to immediate family members (i.e., spouse, children and grandchildren) of a Primary Member. Children must be 12 years of age or older and accompanied by adult member),

Non-Member Guests shall pay $15.00 per hour for range use and must be accompanied by a member, and, be at least 18 years of age. All Club rules and regulations must be followed by Guest. Member is responsible for Guests actions. Guests may attend once per week.

Mail form with check made out to SMLPSA back to:

SMLPSA Membership Application and Renewal

12787 Booker T. Washington Hwy, Suite 104, PMB 204, Hardy, VA 24101

Any Questions Please Call:

Giff Swayne, SMLPSA Club Secretary at 540-565-0207 or email at .

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