Gun Owners of America
8001 Forbes Place, Suite 102
Springfield, Virginia 22151
Telephone: 703/321-8585

__ Count me in! Here is my contribution to help preserve my right to keep and bear arms
and to join Gun Owners of America. I understand that a minimum donation of $20 entitles
me to full membership benefits.

____ $20    ____ $35    ____ $50    ____ $100        Other $____

__ I will become a Life Member. My down payment on the $500 cost is:
(balance billed in $50 quarterly increments)
 
____ $50    ____ $100    ____ $150    ____ $200    ____ $250    ____ $500

Name: (Mr. Mrs. Ms. ______ ) ______________________________________

Address:     _____________________________________________________

City / State / Zip Code:    ___________________________________________

Telephone Number:          ___________________________________________

Email Address:                   ___________________________________________

 
Please make check payable to Gun Owners of America or GOA
Your contribution to GOA is not deductible for income tax purposes.
Please allow up to 4 weeks for your new member packet to arrive.

Please charge my   Visa / MC / AmEx / Disc
In the amount of   $________

Card number               __________________________________________

Exp. Date                    __________________________________________

                                     __________________________________________
                                    Signature (required on credit card purchases)