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Fitchburg Sportsmen’s Club, Inc.
PO Box 594
Fitchburg, MA 01420
www.fitchburgsportsmensclub.org

2011 Dues Renewal Form

Date:		 2/6/2012    

Name:		 FSC Member #:

Address:		 Date of birth:

City/State/Zip		 Telephone:

Email:


Fees for new members and renewals were voted in on February 6, 2006.
select one Membership Type Renewal Fee Renewal Late Fee
Junior (15-17 years old) $27.50 $10.00

Regular (18 - 64 years old)

 $55.00 $10.00
Senior (65 and older) $36.00 $10.00
Family $65.00

$10.00
Senior Family $46.00

$10.00


AMOUNT ENCLOSED FOR MEMBERSHIP RENEWAL:   $





Number of " 300 Drawing" tickets you'd like to purschase,      x   $10 each =

AMOUNT ENCLOSED FOR TICKETS:     $
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