Regular Membership
On-Line Application...
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The "Long Island Shooting Center Gun Club" is an NRA Certified shooting facility.
Please allow 7 business days to receive your membership documentation. If you prefer,
you may fax the information below to (631) 665-7002 or call us at (631) 665-7011.


        First Name: 
       Middle Name:  "None" If no middle name
         Last Name: 
    E-mail Address:  i.e. john@erols.com

     Street / Apt#: 
       City / Town: 
             State: 
               Zip: 

      Phone Number: 
     Date of Birth:  MM/DD/YYYY
        Occupation: 

NYS Pistol Permit#: 
        Issue Date:  MM/DD/YYYY

  Drivers License#: 
   Expiration Date:  MM/DD/YYYY


               Regular Membership Dues Include New York State Sales Tax
         Duration:   1 Year $200.96     3 Years $450.79
 Credit Card Type:   MasterCard   Visa  Discover

       Card Number: 
   Expiration Date:  MM/YY
    Card Issued To: 
Please use the space below for comments, (if necessary):


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E-mail Address: email@lisc.net