Membership Form 2023

MEMBERSHIP FORM
Membership Benefits: As a member, you will receive regular communications, match results, and notice of registration for upcoming shoots or clinics. You are entitled to vote at club meetings. You will help promote GUN SAFETY as well as enjoy being a part of a fun, family sport.
Name*
D.O.B.*

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Address*

Address

Street Address Line 2

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Zip Code
Email*
example@example.com
Phone*
Membership Type*

New:Renewal:
CMSA #*
CMSA Class*
CMSA Exp. Date*

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Family Members: (for family membership only) Those living under the same roof in a spousal relationship and/or their children under the age of 21.
Name
DOB

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CMSA #
CMSA Level
CMSA Exp Date

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Name
DOB

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CMSA #
CMSA Level
CMSA Exp Date

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Name
DOB

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CMSA #
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CMSA Exp Date

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Individual Membership:
• 12 years of age and up as of January 1st $30.00 (via PayPal $31.00)
12 & Under $20.00 (via PayPal $21.00)
Associate membership (non-rider) $20.00 (via PayPal $21.00)
Up to 4 family members $50.00 (via PayPal $52.00)
Total Owed*
Makes Checks payable to: Northeast Six Shooters

Membership Dues paid through PayPal will have to pay PayPal fees

For more information contact: n6s.club@gmail.com or go to: https://www.nesixshooters.com
Liability Release Form
I understand that I am participating in a sport which contains dangers, and risks may arise, including, but not limited to, accidental injury, the forces of nature and illness. In consideration of the right to participate in these events and the services provided for me by the Northeast Six Shooters or Cowboy Mounted Shooting Association and its agents, I have and do hereby assume the risks associated with such events. The contestant shall at his own expense, defend management and/or all sponsors, their members, or employees from any and all such claims and indemnify, from any and all liability, damage and costs arising from injuries to person or property occasioned by any act or omission of the contestant.

I agree my likeness may appear in any club publications or advertisements.
Mail completed form and check to:

Molly Slombo 234 Stockbridge Corner Road, Alton, NH 03809
Signature*

Clear
Date*

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Should be Empty:

MEMBERSHIP FORM

Individual Membership:

Liability Release Form