MIDNIGHT SUN MUZZLELOADERS*

536 KEELING RD.

NORTH POLE, AK 99705

Date _____/_____/_____

Name(s)___________________________________________________________

Address ___________________________________________________________

City ______________________ State ______ Zip Code _______________

Phone # (____)__________________, (_____)____________________

Home Work

Annual Membership Dues (circle one): $20.00 Family, $15.00 Single

NMLRA Member # (Self) ____________________ Exp. Date ________________

(Associate) ____________________ Exp. Date ________________

NRA Member # ____________________________ Exp. Date ________________

Please check your interests in Muzzleloading or Blackpowder Shooting Sports :

Flintlock ___ Percussion ___ Shotgun ___

Pistol ___ Breechloader Metallic Case ___ Living History ___

Rendezvous ___ Building muzzleloaders ___ Hunting ___

Other ______________________________________________________________

Mail dues with this form to the above address or bring it to the next meeting. The Club meets the third Tuesday of the month, October through May.

* A National Rifle Association affiliated organization.