INDIVIDUAL MEMBERSHIP APPLICATION

TITLE (Mr., Mrs., etc.): _______ FIRST NAME: ___________________________________________

LAST NAME: _______________________________________ MIDDLE INITIAL: _______________

ADDRESS: _________________________________________________ APT. NO:________________

CITY: _______________________________________ STATE : ______ ZIP: ____________________

HOME PHONE: ( _____)_____________________WORK PHONE: (_____)_____________________

SHOOTING RELATED AFFILIATIONS

NSCA (Number) ___________________________ PASS (Number) _____________________________

WCSN (Number) ___________________ Other (Organization Name/Number) ____________________

The North Carolina Sporting Clays Association (NCSCA) is dedicated to supporting the shooters and sporting clays

ranges within North Carolina . To help your organization support your individual needs, please provide items of interest

to you that could further interest in sporting clays shooting in North Carolina .

  ___________________________________________________________________________________

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COMPLETE THE ABOVE INFORMATION; A ONE TIME $10.00 DONATION IS APPRECIATED

(MAKE CHECKS PAYABLE TO NCSCA)

  MAIL TO –   NORTH CAROLINA SPORTING CLAYS ASSOCIATION

     221 BIRDIE DRIVE

    STANLEY, NC 28164

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