Membership Application

GALESBURG RIFLE CLUB, INC.

Name________________________________________________________________

Address______________________________________________________________

City____________________________ State_________________ Zip_____________

Phone__________________________ Date of Birth___________________________

Email address_________________________________________________________

I hereby make application for membership in the GALESBURG RIFLE CLUB, INC. and agree to conform to its By-laws and Amendments and subscribe to the following Oath of Allegiance:

I pledge allegiance to the flag of the United States of America and to the Republic for which it stands. I certify that I am a citizen of the United States and that I am not a member of any organization or group pledged to or working for a program aimed at the destruction of our present system of government established by the Constitution of the United States of America.

                                                        Signature__________________________________

Recommended by Club Member___________________________________________

Enclose new member fee:   $70.00.    $5.00 credit each for ISRA and NRA membership.

Are you a member of the ISRA?  No___ Yes___  #______________________________

Are you a member of the NRA?  No___  Yes___ #______________________________

Family membership available–spouse and or child (age 18 or under) in same household.

Contact Club Secretary, Mr. John Chaney 309-335-3093 with questions on fees.

Return application to:         GALESBURG RIFLE CLUB, INC.

                                                           P.O. Box 1190

                                                            Galesburg, IL 61402-1190

This application approved by the Board of Directors:

Date:__________________________ Secretary________________________________