This form may be printed out and submitted to USPSA by US mail to the above 
address for processing.
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USPSA Membership Application


Name: __________________________________________________________________


Address: _______________________________________________________________


City & State: ___________________________________________ Zip:_________


Phone Number (_______) ________________________________________________

I am applying for the following type of membership:

   [ ] Annual               $40.00 US
   [ ] 3-year              $105.00 US
   [ ] 5-Year              $175.00 US
   [ ] US Annual Associate  $25.00 US
   [ ] US 3 Year Associate  $75.00 US
   [ ] US 5 Year Associate $125.00 US
   [ ] U.S. Life           $500.00 US
   [ ] Foreign Annual       $50.00 US
   [ ] Foreign 3 Year      $135.00 US
   [ ] Foreign 5 Year      $225.00 US
   [ ] Foreign Life        $600.00 US
   [ ] Benefactor         $1000.00 US

Is this a    New Application or   Renewal of (USPSA#)__________________

(Note: Life and higher may be paid in four equal payments over a period of one 
year.  Credentials are issued upon completion of payments. Foreign rates apply 
to those members with mailing addresses outside the United States).


Visa    Master Card     #______________________________ Exp: _______

According to the legal requirements of the United States are you able to 
purchase and possess firearms?    Yes    No     Junior, Not Applicable

   I hereby make application to join the USPSA under the plan and terms as 
noted above.  I certify that I will use the skills and knowledge gained in 
USPSA/IPSC practical shooting only in lawful sporting activities and self 
defense; that I will conduct myself in such a manner as not to bring the sport 
of practical shooting into disrepute.

Please sign and enclose check (in U.S. Funds) for appropriate amount.  I 
understand there will be a $15 handling fee for all returned checks.



Signed: _____________________________________________ Date: ___________


UNITED STATES PRACTICAL SHOOTING ASSOCIATION
P.O. Box 811, Sedro Woolley WA 98284
(360) 855-2245 voice
(360) 855-0380 fax