Membership Application
Please read carefully and fill out completely
Incomplete and/or illegible applications will not be processed and returned.
First Name: Last:
Street Address: Apartment/Suite/Lot:
City: State: Zip+4: -
Home Phone:() - Work Phone:() - Cell Phone:() -
Occupation: Supervisor:
E-mail: NRA Membership #:
I hereby certify that I am a citizen of the United States of America, or a legal resident alien; that I am not a member of, or associated with any organization which has, as any part of its agenda, advocates the violent overthrow of the United States Government, and/or any political group by violence; that I have never been convicted of a felony, and/or crime of violence; and if admitted the club, I will faithfully endeavor to fulfill my obligation of good sportsmanship, stewardship, obey the range safety rules, and comply with the by-laws of the club. _____ (Initials)
* Aggressive, Belligerent, and/or Condescending behavior will be grounds for expulsion and loss of membership. _____ (Initials)
The Phoenix Rod & Gun Club (PR&GC) is affiliated with the Civilian Marksmanship Program (CMP) and leases land from City of Phoenix Parks department. Membership and shooting opportunities are available without regard to adult age, race, national origin, religion, and/or sex. _____ (Initials) Government reporting requires that the following demographic information be collected.
Date of Birth , Race: Sex:
Membership fees: Annual memberships are valid from September 1 through August 31 of each year
(note, if joining after Jan-1, pay 75% of dues, after Apr-1, pay 50%, after jul-1 pay 125% which is the last quarter plus all of the next years dues)
Annual Individual $90.00 (note, if joining after Jan-1, pay 75%, after Apr-1, 50%, after jul-1 pay 25% plus all of next years dues)
*Annual Family $100.00 Spouse and legal children under the age of 23 residing with parents
5 Year Individual $360.00
*5 Year Family $400.00 Spouse and legal children under the age of 23 residing with parents
Annual Corporate $500.00 Call (602) 276-0510 for more details
Initiation Fee $75.00 (one-time fee only, not pro-rated, can be reduced to $50, see the range master for details)
Hard copy of news letter $5.00 (four editions per year mailed via USPS)
Amount Enclosed $
* Spouses Name:
Child Name: Birth Date:
Child Name: Birth Date:
Child Name: Birth Date:
Child Name: Birth Date:
Make checks or money orders payable to: Phoenix Rod and Gun Club
Note, this is an application only and if approved will result in probationary membership,
Full requirements of membership must be met prior to approval to full membership, see membership qualification procedure for details.
Fees can be paid in entirety with the application or half upon application and half upon approval to full membership.
I am interested in: Bullseye Pistol Competition Highpower Rifle Smallbore Rifle Air Rifle Air Pistol Olympic Shooting
Practical Firearms Junior Marksmanship Shotgun Black Powder Assist in club events and/or activities.
Release from Liability and No Harm Hold Agreement
I understand and fully aware of the risk and hazards of participating in any activity conducted by, and/or coordinated by the PR&GC. _____ (Initials)
In participating in any activity coordinated and/or conducted at the PR&GC, I do so voluntarily and in my individual capacity. _____ (Initials)
As to any activity coordinated by and/or conducted at the PR&GC in which I participate , I fully understand and agree that I will be responsible for all my own actions. _____ (Initials)
I hereby expressly assume all risk of loss, damage, and/or injury, to my property and/or person(s), including death, that I may sustain by reason of and/or in connection with participation in any activity coordinated by and/or conducted at the PR&GC. _____ (Initials)
I hereby represent and/or acknowledge that I have read this waiver and release from liability, fully understanding each and every provision listed above, and have on this date voluntarily executed the same. I further represent and/or warrant that I am of at least eighteen (18) years of age and have the legal capacity to execute this agreement, unless cancelled by myself in writing, this waver is to have full effect at all activities and events during the term of the membership. _____ (Initials)
Signature: ____________________________________________________________ Today's Date:
Print out this form, sign it, enclose payment, proof of safe firearms handling, and mail to:
Phoenix Rod & Gun Club
Membership Secretary
915 West Olney Drive
Phoenix, AZ 85041-8925
- Please allow 10 to 15 days for payment to clear and processing -