Name_________________________________________________

Alias__________________________________________________

Address_______________________________________________

Phone_________________________________________________

E-Mail_________________________________________________

SASS #________________________________________________

RO 1___ RO 2___

NRA Member Yes_____ No_____

LIPSA Member Yes____ No_____

Pistol License # _________________________________________

Membership Fee-$85 (Shoot Free)

$35 ($25/Match)

All Shadow Rider & LIPSA members have access to the shed full of targets and such.

Check Payable to-"Shadow Riders"

Dues will be collected at the June 2008 meeting or

mail to:

Steve Claypool

PO Box 800

Southold, NY 11971

631-477-1090