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BOOTHBAY REGION FISH & GAME
ASSOCIATION, INC
P. O. Box 408, Dover Road, Boothbay, ME 04537-0408
www.brfga.com
Application for new membership must be presented in person at a regular monthly meeting
Meetings are at 7:30 PM on 3rd Weds of every month at the clubhouse.
Part I.
Date: ___________
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I hereby apply for ____New Membership / ____Membership Renewal in the Boothbay Region Fish and Game Association, Inc. for myself (and for my dependents) as indicated below. I (we) agree to abide by the Constitution, By-Laws, rules and regulations of this association, and further agree to follow the rules of good sportsmanship, and support the Association in whatever ways possible. (Renewals need only complete parts I and IV) |
Name: _________________________________________________________________
Tel. #: _________________________________________________________________
Mailing Address: _______________________________________________________________________
Home Address: ________________________________________________________
NRA Member, ____Yes, ____No.
E-mail Address: ____________________________________________(Please Print)
Membership Request: ___ Regular $35.00 ___ Family $40.00 ___ Junior $ 5.00
Total Enclosed $__________
Part II. Please check any of the following activities that interest you.
___ Fly Fishing ___ Salt Water Fishing ___ Upland Game Hunting
___ Boating ___ Fresh Water Fishing ___ Big Bore Rifle & Target
___ Pistol ___ Snowmobiling ___ Small Bore Rifle & Target
___ Archery ___ Reloading ___ Big Game Hunting
___ Camping ___ Water Fowling ___ Small Game Hunting
___ Other ___ Skeet / Trap ___ Muzzle Loading
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I am interested in serving on a committee, __Range, __Archery, __Fishing, __Others
Part III.
Please indicate any special qualifications (NRA Instructor, NSSA referee, etc.) or experience you have had which may be of benefit to the organization
___________________________________________________________________
Remarks, or additional information of note: ______________________________
___________________________________________________________________
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Part IV. 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: .
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For Association Use Only
DUES PAID: MEMBERSHIP CARDS ISSUED:
BUTTON: GATE KEY:
Please print out the above form, fill it in and mail it with your dues. Better yet bring it to a meeting.
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