St. Marys Sportsmen's Club 2012 Membership Application

Instructions: Please print-out a copy of this application for each person applying,
complete the form legibly, and mail it with your payment(s) to:

St. Marys Sportsmen's Club
PO Box 958
Saint Marys, PA 15857-0958

Membership type (check one):

    o  Senior  $10.00                  o  Junior  $2.00 (under 16)

Name: (please print) ______________________________________________________

Address: _______________________________________________________________

City: __________________________________________   State: ______   Zip: ______________

Phone: ___________________________

Email: ___________________________________________________

2012 Coyote Hunt Registration

If you would like to register for our Annual Coyote Hunt, please check the box(es) below and remit the registration fee of $8.00 (in addition to the membership dues, if not already a paid 2012 member).

$7.00 registration fee for prize money and $1.00 administration fee.

Mail-in registration must be received by February 11, 2012 and must include fee and a Self-Addressed Stamped Envelope.

 o Yes, I would like to register for the 2012 Coyote Hunt and have read and understand the rules and regulations for the hunt.

 o I have previously received my 2012 Membership. My 2012 Membership number is: _______________.

Coyote Hunt T-shirt Orders

Shirts are $10.00 each in Medium, Large, Extra-Large.
If the shirts are to be mailed, please add $3.00 shipping/handling charge for each shirt.


Medium T-shirts at $10.00 each = $___________


Large T-shirts at $10.00 each = $___________


Extra-Large T-shirts at $10.00 each = $___________

Total for T-shirts   

= $___________