Header Graphic
Membership Application/Renewal

Membership Application Form

  BOOTHBAY REGION FISH & GAME ASSOCIATION

NEW MEMBERSHIP/ RENEWAL APPLICATION

 

Single  Membership Dues $50.00     Family Membership Dues $65.00

Single Membership _____ Family Membership: _____

NEW MEMBER ONE-TIME APPLICATION FEE: $25.00

LAPSED MEMBERSHIP REINSTATEMENT FEE (2 yrs. or more lapsed membership): $25.00

THIS APPLICATION IS FOR: NEW MEMBER _____ RENEWAL _____ REINSTATEMENT______LIFETIME ­­­_____

A family membership includes up to 2 heads of household & only dependent children under the age of 18. You must provide names of dependent children on back of form along with DOB for each. All persons age 18 or over (including children of members) must have their own memberships.

Name: ___________________________________________ Tel. #: _________________________________________

Mailing Address:__________________________________________________________________________________

 E-mail Address (please PRINT clearly)_________________________________________________________________

 Number of cards needed ___ Name(s) on card__________________________________________________________

 

NOTE: The annual membership period runs from the Annual Club Meeting in January of the current year to the Annual Club Meeting in January of the next year.

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. I attest that I will not use the club firing ranges until I have successfully completed a formal Range Orientation Session. Furthermore, I understand that persons under the age of 18, including my dependent children/family members, are prohibited from using the firing ranges unless accompanied and closely supervised by a parent or other BRF&GA member in good standing over the age of 21 who has completed a Range Orientation. I agree to abide by all BRF&GA bylaws, rules and regulations (visit www.brfga.com). Finally, I state that I have read all of the above and have kept a copy for my own information.

SIGNATURE: ____________________________________________________________ DATE____________________

NEW MEMBERS: Print out and bring to a meeting with check/cash for your annual dues & application fee (checks to be made out to BRF&GA). Meeting are held on the 3rd Wednesdays of each month.

RENEWALS: Print out and bring application and check/cash to a meeting, renew in person at TDR Auto Supply at 14 Oak St. in Boothbay Harbor, or mail check and application to:

BRF&GA   P.O. BOX 408 BOOTHBAY, MAINE 04537-0408

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

For Office Use Only:     S/O date and given by:                                                                       Pin/card(s) given:  Y / N

                                          Membership year(s):                                                                          Donation:

                                          Committees:


DOWNLOAD AND PRINT APPLICATION (CLICK)


 


 

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 - 2020 Boothbay Region Fish & Game Association

***

Web Design by KaSondera at: www.completewebpagedesign.com

Scroll to Top