NASSA Membership/Match Application

 Print out this form, fill it out, and send it with
 your payment to the address listed below.

Personal Information

Name (Please print) ______________________________ Street address ______________________________ ______________________________ City, State, Zip ______________________________ Home phone number ______________________________ FAX number ______________________________ E-mail address ______________________________ Club affiliation (if applicable) ______________________________ NRA ID (if applicable) ______________________________ USA Shooting ID (if applicable) ______________________________ NASSA ID (if applicable) ______________________________ Venue (circle one) Rifle / Pistol / Running Target Date of birth Month:___ Day:___ Year:___ Age: ___

Postal Match Information

I want to participate in NASSA's, postal match program. (circle the price that applies) Annual dues are from October-September of any given year. Prorating will occur @ $2.10 per month if joined after October. # Months* P1 P2 P3 1 $5.00 $7.50 $10.00 3 $12.99 $20.50 $28.00 6 $25.98 $41.00 $56.00 12 $51.96 $82.00 $112.00 *NASSA members: save $2.00 every three months when you pay ahead for 3, 6, or 12 months!

Membership Information
I want to join NASSA (circle one) Check #: ________ Date     : ________ Annual (new members): $25.00 US Family: $50.00 US Life: $240.00 US Referred by ______________________________ NASSA ID of referring member ______________________________

Make checks payable (in U.S. funds) to E. C. Wong (Pistol Account), and mail completed form with payment to: NASSA / Membership & Statistical Office / 2103 Wheaton Drive / Richardson, TX 75081