NORTH COUNTY SHOOTIST ASSOCIATION

MEMBERSHIP APPLICATION FORM

Date___________________________ Renewal___________

Name__________________________________________ New Membership_____

Street Address________________________________________

City___________________________________________State___________Zip_______

Telephone Number (______)________________________

NRA#__________________CRPA#__________________SASS#__________________

Membership yearly cost is $45.00. As of 1

Feb. 2007. Per family, includes children under 18

I am interested in the following shooting venues:

SASS Cowboy Action shooting __________Your Alias__________________________

NCSA Hi-Powder Rifle_____________ BPCR silhouette_________________________

Varmint Rifle Silhouette__________ Cowboy lever action Silhouette________________

Hunter Pistol Silhouette____________ Recreational Shooting _____________________

IPSC (LDF)____________Long Range Buffalo Shooting__________________________

Hi-Power Rifle Silhouette_________________

Send your completed application to NCSA. Make checks out to NCSA

Prior to shooting at the range you will have to fill out and sign a waiver of Liability for you and each member of your family that will use the range. You will also receive a membership card.

NCSA

C/O Harold Itchkawich

536 Mimosa Ave

Vista CA 92081-8117

You may check our club web page for detailed information www.ncsapala.com

You may phone Harold at 760-727-9160