Membership Application – Washington Hollow Rod & Gun Club

URL

This field is for validation purposes and should be left unchanged.

Your Name(Required)

First Last

Street Address

City, State and Zip / Postal Code

Your Email Address(Required)

Email Address Confirm Email Address

Home Number(Required)

Mobile Number(Required)

DOB(Required)

NRA Member Number

Type of shooter

Pistol

Rifle

Shotgun

Employer Company Name

Employer Phone Number(Required)

Below please list 3 references who have known you for at least 5 years.

Reference 1 Name

Reference 1 Phone

Reference 1 Email

Reference 2 Name

Reference 2 Phone

Reference 2 Email

Reference 3 Name

Reference 3 Phone

Reference 3 Email

Sponsor Name

Please attach a photo of Driver's License & Pistol Permit

Max. file size: 256 MB.

Signature

Signature Date

I hereby apply for membership in the Washington Hollow Rod & Gun Club, Inc. and agree that if I am voted into membership, I will abide by all of its regulations & By-laws. I further certify that all the forgoing answers are true and that any false statements result in the forfeiture of membership and fees.

Initiation is $250
Full membership $225
*Prices subject to change
Processing fee $25