NEW MEMBER ( ) RENEWAL ( )

NAME__________________________________________________________________

ADDRESS______________________________________________________________

CITY / STATE / ZIP CODE________________________________________________

PHONE: HOME___________________________ WORK_______________________

E-MAIL____________________________________

USPSA # ____________ CLASS.....OPEN_____ LIMITED______LIMITED-10______

PRODUCTION______ REVOLVER_______ SINGLE STACK______

R.O. CERTIFICTION____ FEMALE ( ) JUNIOR ( ) SENIOR ( ) SUPER SENIOR ( )

SPECIAL SKILLS________________________________________________________

_______________________________________________________________________

The yearly dues are $35.00. Any immediate family members may join for an additional $25.00.

Please make checks payable to K.A.P.S. and mail to the above address or turn in by match day of February 2008.

Should you have any comments or suggestions, please write them on the back of this form.

Please feel free to reproduce this form for your friends and family.