Circle New or Renewal <> Membership Class
(Please Circle One Below):
Annual-$15 Life-$300
Benefactor-$450 Junior-$2
Club-$7
Club Name, If Applicant is a Club: ____________________________________
Last Name _______________________ First Name ______________ MI ____
Other Club Membership(s): _________________________________________
Mailing Address: _________________________________________________
City/Town: ______________________________ State ______ Zip __________
Phone Number: ( ) _____-_________ Age:_______
E-mail Address: __________________________________________________
PTSR&PA uses email for correspondence, if you want correspondence
by USPS mail you must submit a separate letter stating this.
Do you want a membership card? YES____ NO____
The Pine Tree State Rifle and Pistol Association Pledge:
I certify that I am a citizen of the United
States; that I am not a member of any organization which has as any part
of its program the attempt to overthrow the government of the United States
by force of violence; that I have never been convicted of a crime of violence,
and that if admitted to membership I will fulfill the obligations of good
sportsmanship and good citizenship.
Signature of Applicant ___________________________
Date: _________
Please make check payable to Pine Tree
State Rifle and Pistol Association and mail to:
PTSR&PA
ATTN: Angus Norcross
14 Pine Street
Wiscasset, ME 04578