Membership Application

 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) ____________________________________________
Address (printed)___________________________________________

City _______________________________________________________
State__________________ Zip Code ____________________________

Home Telephone (include area/country code)__________________________
Business Telephone___________________________________________

E-Mail ____________________________________________________________

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.)

Signature ________________________________________________
Date _______________

Mail to:

Weatherby Collectors Association, Inc. - P.O. Box 1217 - Washington, Mo. 63090

(For secretarial use only)

Date Received_________Date Acknowledged_________Member #_________