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amount received                                           APPLICATION FOR MEMBERSHIP
$____________                                              ALIQUIPPA BUCKTAILS LEAGUE
check number if            applicable                                  P.O. BOX 1431 - Aliquippa, PA 15001
# ____________  
for membership fees in the Aliquippa Bucktails First: _______________________ Initial: ___  Last: ________________________        Date: ___\___\___

       League

 Address: __________________________________________________City: ______________________
  State: ________________  Zip: ________  Phone # _____-_____-_________ email _____________________
  I give my pledge as an American to save and faithfully defend from waste the natural resources of my country .. its air, its soil, and minerals, its forest, waters and wildlife.
Date Paid  
______________ Junior Member __                                      Regular Member ______                                Senior Member ___
   
Payment Collected By

Favorite Activity
____________________  

 

 Rifle  __                         Archery  _____                  Trap & Skeet  ___                         Indoor Pistol ___
Signature: ______________________________      Recommended By: _______________________________