South County Archers
www.southcountyarchers.com
Jefferson Barracks Archery Range
Application for Membership/Renewal Form

Name: ________________________________________

Address: _________________________________________

_______________________________________
City / State / Zip Code

Phone:

Home (_____) _____________________

Work (_____) _____________________

Cell (_____) _____________________

E-Mail __________________________________

Type of membership:
Individual - $25.00
Family - $30.00

Family membership information:

Spouses name: __________________________________________

Childrens Name / Birth Date

_________________________________

_________________________________

_________________________________

_________________________________

Return to:
Jeanine Smith
South County Archers
600 Tanya Drive
St. Louis, Mo. 63129