The Bar-20, Inc.

Membership Form

Date________

Last Name________________First_______________MI___ DOB________

Alias____________________________

(70 or older, Free Membership. (Need to be paid member for 3 years)

Address ________________ City______________

State___ Zip______

Day Phone____________ Evening Phone____________

NRA Member Y__ N__Life__ NRA#____________

SASS Y__N__ Life__SASS #_____________

NYS Pistol Permit #_________________(must be on your person)

S/A Revolver___________Cal.___ L/A Rifle___________ Cal.____

Shotgun_________ Type________ Ga._____

eMail Address__________________________

(We can eMail Shooting Scores and Newsletters

for faster response. Regular Pony Express for those without eMail).

Spouse: (If not a shooting member)

First Name____________ M/D of Birth_________

Yearly Dues: $25.00, due in January of the New Year.

Made payable to: The Bar-20, Inc.

Send dues and completed form to:

Rodney "R L Trooper" St. Clair

P.O. Box 192

Madison, NY 13402

(315)893-7917