2010 MEMBERSHIP RENEWALS
Single Membership $35.00 Family Membership $40.00
__ Single Membership __ Family Membership: __ Are you an NRA Member?
Number of keys needed _________.
Name: ___________________________________ Tele : ___________________________
Mailing Address: ______________________________________________________________
_____________________________________________________________________________
E-mail Address: _________________________________Please print clearly
May we call you for work at the Club? ; __ Carpentry __ Painting __ Roofing __ Grounds __ Other
I can work: __Weekdays __ Saturdays __ Sundays
Will you serve on a __ Fishing, __ Range or __ Archery committee?
Comments: _________________________________________________________________
LIABILITY RELEASE: As a member of the Boothbay Region Fish and Game Association, Inc., I agree to waive and release from liability and agree to hold harmless the following: The Boothbay Region Fish and Game Association, Inc., its elected officers and representatives, for any and all damages of any kind or nature to my person and property arising out of or resulting from my direct or indirect participation in any and all Association activities or exercises of membership or privileges. Finally I state that I have read all of the above and have kept a copy for my own information.
DATE:______________ SIGNATURE: _________________________________________
DATE:______________ SIGNATURE OF WITNESS: _____________________________
Mail to:
BOOTHBAY REGION FISH & GAME ASSOCIATION
P.O. BOX 408
BOOTHBAY, MAINE04537-0408
Click here to print the form.
Please print out the above form, fill it in and mail it with your dues. Better yet bring it to a meeting.
