Family Membership Application

Questions? Click here for help


Please fill in to register or renew your membership.

Current ASA Member#   

 

 

New Membership 

Renewal

 


Type of Membership:

One Year Family ($40): Spouse & Children under 21

   


 

Name of Primary member

As you wish it to appear on your membership card

  D.O.B.
mm/dd/yyyy
Primary   / /
Spouse   / /

Family 1   / /
Family 2   / /
Family 3   / /
Family 4   / /
Family 5   / /

Address:        
City:    
State: E-mail:
ZIP: ie. 12345-6789    
Phone:  (Cell) --ie. 123-456-7891 (Work) --ie. 123-456-7891

Payment Information:  Total: $  
 
Credit Card Number:  ---
Enter your Credit Card Number exactly as it appears on your card in the format  0123 4567 8910 1112
Expiration Date /
CVV2#  

The CVV2 # is three numbers on the back of the card that are printed in the signature area that follow the last four digits of the credit card number. It must be entered for us to process your order. (click for more)


 The following must be completed 
Cardholder Name:  
Cardholder Address:  
Cardholder City         
Cardholder State       
Zip
 

OR: print this form, Fill out and mail to:

Archery Shooters Association

PO Box 399

Kennesaw, GA 30156

 

Or you may also Fax this completed form to: 770-795-0953