MEMBERSHIP APPLICATION for THE BRAZOS VALLEY SERVICE RIFLE ASSOCIATION
Mail the completed form to:

 BVSRA

c/o Rick Conner

PO Box 37

Lyons, Texas 77863

NAME:                         ________________________________________________________________________

BIRTH DATE:               ________________________________________________________________________

MAILING ADDRESS: ________________________________________________________________________
		                Number and Street Name or P. O. Box

                                     ________________________________________________________________________
                         		City, State, Zip Code

TELEPHONE NUMBER:   (______)________-_____________                 	               	

EMAIL ADDRESS:______________________________________________________

NRA MEMBER NO.:________________________________NRA CLASSIFICATION:_____________________

Membership Fees: First Time $50.00   Annual Renewal $20.00   Full-Time Student $20.00

Spouse and children of the member are also eligible to be non-voting members at no additional cost.
Children may participate without individual membership from the age of 9 to 21, (25 if a student).
 List the name, age, birth date, and NRA Member Number of family members.

NAME:_____________________________AGE:_____B/D:_________ NRA NO.:_________________________

NAME:_____________________________AGE:_____B/D:_________ NRA NO.:_________________________

NAME:_____________________________AGE:_____B/D:_________ NRA NO.:_________________________

NAME:_____________________________AGE:_____B/D:_________ NRA NO.:_________________________

I agree to abide by the bylaws of The Brazos Valley Service Rifle Association and will be responsible 
for the conduct of all family members listed on this application.

SIGNATURE:_________________________________________________   DATE:________________________