GO-NH, Inc. Membership Application

__New Membership       __Renewal (Member Number: __________ )

Name__________________________________________________

Address_______________________________________________

City/Town_____________________________________________

State_______________ ZIP___________

Today's date____________________________

Telephone_______________
E-mail (optional, but by providing your e-mail you will be put on our E-blast list and you will get alerts immediately via e-mail)__________________________________

By applying for membership, I certify that I will support and further the purposes of this organization. Anyone who is not prohibited by state or federal law from owning a firearm is eligible to become a member of GO-NH upon payment and acceptance of dues.

Method of Payment: ___Cash __Check ___Visa____Master Card

 Card # __________________________________

Expiration date ____/____ CID______(this is found on the backside of your card, the last three numbers on the right.) 

Name as printed on card____________________________________________

 Signature______________________________________

 __Junior (under 16) $10.00 __Individual 1 year $20.00
__Individual 3 years $55.00 __Individual Life $300.00 (Birthdate:_______________)
__Family 1 year $25.00 __Family 3 years $70.00
__Club 1 year $30.00 ___Club 3 year $80.00
__Business 1 year $50.00 ___Business 3 year 135.00

__Benefactor $1000.00

I would like to help with:
__Fundraising __Club Liaison
__Education & Training __ Legislative work
__Membership Recruiting __Sportsmen's Shows __Other

Please allow 6 to 8 weeks for processing. Mail this completed form with payment to:
GO-NH, Inc., P.O. Box 847, Concord NH 03302-0847

2004 Gun Owners of New Hampshire
http://www.gonh.org/membership_application