STOCKERTOWN ROD & GUN CLUB
                                                                                 Membership Order Form 2024

Adult (age 16 through 64)   $50.00
Junior (age 10 through 15)  $25.00
Senior (age 65 or older)      $25.00
3 years Adult, covers 2024, 2025, and 2026   $125.00

PLEASE INCLUDE A NAME AND MAILING ADDRESS FOR EACH MEMBERSHIP ORDERED

1) NAME ___________________________________________________________________
Age (for Junior or Senior) _______
MAILING ADDRESS
____________________________________________________________________________
CITY _____________________________________ STATE ________ ZIP _______________
Phone ________________________________ License Plate(s) # ______________________

2) NAME ___________________________________________________________________
Age (for Junior or Senior) _______
MAILING ADDRESS
____________________________________________________________________________
CITY ______________________________________ STATE ________ ZIP _______________
Phone ________________________________ License Plate(s) # ______________________

Make checks payable to Stockertown Rod & Gun Club
Return to:
STOCKERTOWN ROD & GUN CLUB
PO BOX 485
STOCKERTOWN PA 18083