| I hereby apply for membership in the Weatherby Collectors Association. I certify by my signature below that I am a citizen of The United States, Canada , or ( list country)
and that I am eligible to own or possess firearms and ammunition under the applicable Federal, State, or local laws; that I have never been convicted of a felony and am not now under indictment for such an offense.
Name (printed) ____________________________________________
State__________________ Zip Code ____________________________
Home Telephone (include area/country code)__________________________
I am interested in Weatherby arms in the following fields:
Rifles Pistols Shotguns Commemoratives
I would like my name in membership roster. (Must be checked to have name and address included.)
I do not want my name and address revealed.
Enclosed is my payment of $30.00 (U.S.) for annual dues.
Enclosed is my payment of $500.00 (U.S.) for Life membership.
Enclosed is my first installment of $125.00 (U.S.) for Life membership. I agree to pay 3 more installments of $125.00 (U.S.) quarterly.
Enclosed is my payment of $250.00 (U.S.) for Life membership (over 65 years of age.)
Weatherby Collectors Association, Inc. - P.O. Box 1217 - Washington, Mo. 63090
(For secretarial use only)
Date Received_________Date Acknowledged_________Member #_________