Join or Renew on-line using PayPal secure site: Join On-Line

DATE:__________________                       NEW:___  RENEWAL: ___ 

NOTE:  PPFC Membership runs for a year from join date:

TYPE
Amount
Individual
$30
Family
$40
Student*
$10
Freedom Circle**
$500
*Student membership is for current students enrolled in K-12 or College
**Freedom Circle members will receive a plaque and recognition in newsletter.

Please indicate the membership type and amount submitted:

    ___ Individual $______
    ___ Family $_______
    ___ Student $_______
    ___ Freedom Circle $_______

ADDITIONAL CONTRIBUTION(S):

    Help with Newsletter Expense $_________

    Billboard Fund $_________

    VFW Hall Rental $________ 

    For General Expenses $___________


NAME:______________________________________________________________
            (First)        (Middle or Initial)        (Last)

E-MAIL ADDRESS:______________________________________

STREET (or P. O. Box):_____________________________________________

CITY:____________________________  STATE:_____  ZIP:_______________

HOME PHONE: (____)______________   WORK PHONE: (____)______________

CELL PHONE: (____)________________

NOTE: The Pikes Peak Firearms Coalition seeks to influence
legislation and, as such, dues and contributions are not tax
deductible as a charitable contribution under IRS rules.

Mail application to:	Pikes Peak Firearms Coalition
			PO Box 76521
			Colorado Springs, CO 80970-6521

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