Pennsylvania Sporting Clays Association
Club/Range Membership Application

c/o Jeff Lutz, 10569 Allentown Blvd, Annville, Pa 17003
(717) 534-5506 or (717) 507-4121 --------> www.PaSportingClays.com



Club Name:  ________________________________________________


Mailing Address: ___________________________________________

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Website: ___________________________________________________



Club eMail:  _______________________________________________




Contact Name: ______________________________________________


eMail:   ___________________________________________________


Address: ___________________________________________________

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Phone Numbers:

Club ________________________ Work _________________________

Fax  ________________________ Home _________________________

Dues: $25/year