W.S.M.L.A. Membership Form:

Name:__________________________________________

Name of Spouse:__________________________________

Names of Children (living at home):________________________________

Address:_________________________________________

City:_______________   State:_____________ Zip:__________

Phone:________________ WSMLA#____________________

NRA#_________________ Exp Date:____________

NMLRA#______________  Exp Date:____________

Club Affiliation:_____________________________

Enclose a check for $25.00 made out the WSMLA with the above printed page to:

                    Carrie Gavin

                    216 Valley Circle

                    Riverton, WY  82501

                    frankiegavin@hotmail.com