Juniata County Sportsmen's Association

PLEASE PRINT ALL INFORMATION CLEARLY

Date of application year:

July 1, 20__ through June 30, 20__


Name:_______________________________
Email:_____________________________
Telephone:__________________________
Occupation:_________________________

Address:____________________________
____________________________________
City:_______________________________
State:________________Zip:__________


Membership Type:

Fee:

Additional Notes:

Associate Membership

$20.00

Junior Membership

$5.00

(Children/Youth under 18yrs. old)

Senior Life Membership

$40.00

(60 years of age and older)

Full Life Membership

$400.00

Family Membership

$35.00

(Spouse and children under 18yrs old)


Last Name:

First Name:

MI:

Age:

Spouse:

  _________________________

  _______________________


____


____

Child:

  _________________________ 

  _______________________ 

  ____ 

  ____ 

Child:

  _________________________ 

  _______________________ 

  ____ 

  ____ 

Child:

  _________________________ 

  _______________________ 

  ____ 

  ____ 


Please Sign Here: ________________________________________________________

Make Check Payable To:

Juniata County Sportsmen's Association:
C/O Lisa Longenecker
P.O. Box 80
Port Royal, PA 17082