Use the portion below for SRS Membership Renewal ONLY

Name _________________________________________________________________________
Mailing Address__________________________________________________________________

City/State/Zip___________________________________________________________

Telephone Home _________________________Work_____________________________

E-Mail address___________________________________________

NRA Member       Yes           No
Please list any new shooting discipline or other related memberships

Type of SRS Membership renewal      Junior         Individual      Family

Signature________________________________________________________________

  Paid Cash      Check & Check number _____       Date __________________

                      Please print this page and send it
              with the appropriate amount for membership dues to,
                             P.O. Box 1028
                           Ontario, OR. 97914