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

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 outwide 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
   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: ........