NORTHERN MISSISSIPPI RANGE

ASSOCIATION, INC.

CASS LAKE, MN 56633

Membership Application

CERTIFICATION

 

 

 

 

 

 

 

I CERTIFY THAT I HAVE NEVER BEEN CONVICTED OF A CRIME OF VIOLENCE OR OF A FELONY, NOR AM I CURENTLY UNDER INICTMENT FOR EITHER.

 

I CERTIFY THAT I HAVE NEVER BEEN COMMITTED TO A MENTAL HOSPITAL.

 

I CERTIFY THAT I AM NOT A MEMBER OF ANY ORGANIZATION OR GROUP WHOSE PURPOSE OR INTENT IS TO SUBVERT THE CONSITUTION OF THE UNITED STATES BY FORCE OR VIOLENCE.

 

I CERTIFY THAT I HAVE NO INTENTION OF

UNLAWFULLY USING A FIREARM.

 

WAIVER

 

I DO HEREBY WAIVE ANY AND ALL CLAIMS FOR DAMAGES AGAINST THE NORTHERN MISSISSIPPI RANGE ASSN.INC., IT’S MEMBERS AND/OR BOARD OF DIRECTORS ARISING FROM THE PARTICIPATION IN ANY ASSOC. ACTIVITY OR USE OF THE RANGE.

 

I HAVE READ, UNDERSTAND AND AGREE TO BE BOUND BY THE RULES AND REGULATIONS OF THE NORTHERN MISSISSIPPI RANGE ASSOCIATION, INC. ORGRAIZATION.

 

I UNDERSTAND THAT MY MEMBERSHIP MAY BE CANCELLED WITHOUT REFUND SHOULD I BREACH THE RULES OF THE ORGANIZATION.

 

 

 

Signature:________________________________

 

Dated:______Month______Day_________year

 

 

 

 

 

PLEASE PRINT

 

Date of App:________________________

Last

Name:_____________________________

First

Name:_____________________________

Mailing Address:

__________________________________

__________________________________

City & State & Zip Code

__________________________________

Email address:

__________________________________

Phone#

__________________________________

Membership Categories

      Yearly

NRA member-Family———$25.00

       NRA #________________

      Yearly

Non NRA member-Family—$35.00

Life member____________$200.00

       Yearly

Corporate membership——$100.00

 

 

Mail application to above address or see Mark @ BlueWater Bait, Wayne @Gander Mountain, Bemidji or Dean @ Froggy’s Sports, Cass Lake.   Authorized Membership Card issuing stations.

 

PLEASE SIGN ON BACK!!

 

 

 

 

November 1, 2006—October 31, 2007