Membership Application/Renewal

BRFGA Membership Application and renewals

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.   Renewals may be sent to the club with check, dropped off at monthly meetings or at Timber's Tire & Auto, Wiscasset Rd (Rte 27), Boothbay
 
To renew at OSP, members must present their previous year's club ID card.
 
Meetings are at 7:30 PM on 3rd Weds of every month at the clubhouse.
 
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Please print out the form below using the blue "print" link, fill it in and mail it with your dues.  Better yet bring it to a meeting.
 
Print as Word Document
 
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Part I.

Date: ___________ 

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 $50.00  ___  Family $65.00  ___ Junior $ 5.00

A Family Membership is defined as a maximum of two (2) heads of household, and their dependent children under the age of 18.  Please list:

Head of Household #1________________________ 

Head of Household #2 ________________________

Child____________________d.o.b._________

Child____________________d.o.b. ________ 

Child____________________d.o.b._________

Child____________________d.o.b._________

New member applications require a $25 application fee with 1st year dues. 

 

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

 

  

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: ______________________________

___________________________________________________________________

  

   

 

 

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.
 
Print as Word Document

Boothbay Region Fish &  Game Association

P.O. Box 408, 447 Dover Rd., Boothbay, ME

To email the club: info@boothbayregionfishandgame.com

www.BRFGA.com

© All rights reserved 2016 Boothbay Region Fish & Game Association

 

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