2019 NEW MEMBERSHIP/ RENEWAL APPLICATION
Single Membership Dues $50.00Family Membership Dues $65.00
[ ] Single Membership [ ] Family Membership: [ ] Are you an NRA Member?
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____
A family membership includes up to 2 heads of household & only dependent children under the age of 18.
You mustprovide 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. #: _____________________________
(please print clearly)_______________________________________________________________________
Number of cards needed ___ Name(s) on card __________________________________________________________________________
NOTE: The 2019 annual membership period runs from the Annual Club Meeting on January 16th, 2019 to the Annual Club Meeting on January 15, 2020.
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. and 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). RENEWALS: Bring application and check/cash to a meeting, renew in person at Timber’s Tire & Auto on Rte. 27 in Boothbay (he has paper applications), or mail check and application to:
BOOTHBAY REGION FISH & GAME ASSOCIATION
P.O. BOX 408
BOOTHBAY, MAINE 04537-0408