RETURN TO: Tom Cook, 7311 Chenal Point, Leon Valley TX 78240

TYPE OF MEMBERSHIP
ADULT ($40.00/YR)  _________
JUNIOR ($15.00/YR)  _________                                                                                    
MAKE CHECKS  PAYABLE TO:  STAPC

NAME ___________________________________________________________________________
                                               PLEASE PRINT
STREET ADDRESS _______________________________________________________________

CITY ______________________ STATE _____________ ZIP CODE _______________________

PHONE NUMBER (HOME) ________________________ (WORK) _________________________

E-MAIL ADDRESS _______________________________________________________________
                                         TO BE USED FOR CLUB INFORMATION ONLY (NEWSLETTERS, COMMUNICATIONS, ETC.

NRA MEMBERSHIP # _______________________ TSRA MEMBERSHIP # _________________

CLASSIFICATION & NUMBER (NRA, IPSC, IDPA, IMSA, etc.) ___________________________
If unclassified please check here: __________
Do you have any physical or medical situations that might become a problem in a physically strenuous event? (YES/NO) If yes, explain here:

FAMILY MEMBERSHIP Information
NAMES: _____________________________________ Relationship ___________________________

NAMES: _____________________________________ Relationship ___________________________

DUES ARE PAYABLE WITH THIS APPLICATION. Dues cover January 1st through December 31st of each year. Each January your annual membership fee is due. You will be considered delinquent and subject to loss of membership if dues are not paid by the scheduled March monthly match. Membership is subject to a vote of the executive committee of the South Texas Action Pistol Club.
THE NRA PLEDGE
I Certify- that I am a citizen of good repute of the United States of America; that I am not a member of any organization or group having as its purpose or one of its purposes the overthrow by force and violence of the government of the United States of America or any of its political subdivisions; that I have never been convicted of a crime of violence, and that if I am admitted to membership, I will fulfill the obligations of good sportsmanship and good citizenship.

“I certify that all the information is true and correct. I agree that as a member
 of the SOUTH TEXAS ACTION PISTOL CLUB I will obide by all the the By-laws, regulations, procedures, codes of conduct, and safety rules of this organization.”
 
 

SIGNED: _________________________________________ DATE: _______________________
None of this above information in this application will be released without prior approval of the above signed.