Whitinsville Fish & Game Club, Inc.

New Membership Application

New Club Membership Application:

This form is to apply for a new membership at the club.
Current members that want to renew their Membership can fill out the Membership Renewal Form available here.

Description of Membership Categories:

Senior Membership
(Annual fee: $145.00) 21+ Years Old. Full Membership.
15 Work Hours/Year Required.†

Auxiliary Membership
(Annual fee: $25.00).
5 Work Hours/Year Required.†
Must be spouse or domestic partner residing at same residence

Junior/Senior Membership
(Annual fee: $25.00)
16-20 Years Old. Full Membership.

Junior Membership
(Annual fee: $5.00)
1-15 Years Old. Partial Membership Benefits.

PLEASE NOTE:
Members that wish to enroll Multiple Family Members or Auxiliary Member, please submit one Apllication for each family member.

When Filling Form Below, " * " Indicates Required Fields.

Available Membership Levels: Please select Membership level Please see payment section below listing convenience fees.*

Senior Member (Annual dues: $145.00)Auxiliary membership (Annual dues: $25.00)Junior/Senior membership (Annual fee: $25.00)16-20 Years Old.Junior membership (Annual dues:$5.00)1- 15 Years Old.

If Applying as an Auxiliary Member, Please List the Full Name (& Badge Number if known) of the Senior Member.

Member Contact Information below:

We have no family application form. Each family member applying for membership must complete a separate form.

First name*

Last name*

Mailing address*

Street address line 2

City*

State*

Zip code*

Age Today*

This Is the Age We Use To Base Your Membership Level

Email Address*

Please Double Check Your Email Address for Correctness.

Phone number*

Mobile Cell Phone Number

Who is your Sponsor (Club Member who vouches for you**):

**If you do not have a Sponsor, please type "None".

Vehicle Year, Make, Model/Type, Color & Registration Plate Number & State of Reg.

(eg. 2008 Dodge Ram P/U, Maroon, FW5524 MA)

Please Select Which Items You Currently Hold:

FID - Firearms Identification CardLTC - License To CarryNRA Membership (National Rifle Association)GOAL Membership (Gun Owners Action League)

Please Select at least one (2) Volunteer Committees to Serve on, in order to accumulate Work Hours during the Membership Year. May be changed later as desired or needed.*

Please add any comments or notes relating to your application. Limit 150 Characters.

Entries above are directed to the Membership Chairman0/150

REQUIRED. Acceptance of the Whitinsville Fish & Game Club, Inc. Membership Terms & Conditions *

WHITINSVILLE FISH & GAME CLUB, INC. RELEASE AND

INDEMNITY AGREEMENT

(Please read carefully before signing)

I Hereby release the Whitinsville Fish & Game Club, Inc.

(The "Club"), its officers, directors, members and their agents and employees and those other organizations affiliated with the Club from any and all liability, loss, damage, costs and/or causes of action, including but not limited to all claims for bodily and personal injuries and death and property damage ("claims") arising out of my participation in and firearms (meaning rifle, shotgun or handgun) or archery safety or training courses taught by anyone at the Club or arising out of my participation in or attendance at any organized shooting or archery competition at the Club or arising out of my informal use of the facilities (ranges) of the Club or my presence during such informal use by any other person. I specifically understand that said activities include the operation and use by the undersigned and/or others of firearms and ammunition, archery equipment, range equipment and related devices and materials. This Release is given on behalf of myself, my heirs, successors, executors, administrators and assigns.

Furthermore, I acknowledge that:

a) Prior to actual handling or use of any handgun, rifle, shotgun, ammunition, archery equipment, range or related equipment, I have received instruction on the use of all such firearms and equipment to be used in the activity, including buy not limited to firearms to be used in any safety or training course and fully understand their use and function. I have been provided with and have read the manufacturer's instructions included with each such item.

b) I agree to hold harmless and indemnify the Club and its officers, directors, members and their agents and employees, including said Trustees from and any and all such claims related to my participation in or attendance at any such activity and/or the use of any such firearms, ammunition or equipment.

c) I understand that there are inherent and other risks involved in the use of firearms and ammunition, equipment and related items, including but not limited to target launchers and clay targets in shooting and arrows in archery, and I freely and voluntarily assume and accept those risks.

d) I hereby release the Club and its officers, directors, members and their agents and employees from any and all liability for bodily and personal injury, death or property resulting from the design, selection, installation, maintenance, construction, adjustment, supervision or use of the Club's facilities (including but not limited to the firing ranges) and/or the firearms and/or ammunition and/or archery and/or other equipment used in such activities, including but not limited to any claim based upon negligence, breach of warranty, contract or other legal theory. I accept and assume for myself, my heirs and assigns, the full responsibility for and all such damage, injury or death that may result.

e) This agreement is governed by the applicable law of the Commonwealth of Massachusetts if any part of this agreement is determined to be unenforceable; all other parts shall be given full force and effect.

I, the undersigned, have read and understand this RELEASE and INDEMNITY AGREEMENT. I declare that i have answered all questions in this application honestly to the best of my knowledge.*

Acceptance of Membership:

Granting of Membership is given providing that

1. The Senior Membership Roster is currently open.
Our Membership roster consists of 250 Senior Members.

2. Your Membership will be reviewed at the next scheduled Board of Directors' Meeting and accepted upon a vote of the Board.

If for any reason we cannot accept your application, your payment will be refunded immediately to the credit/debit card it was charged on.

Duration of Membership:

Membership is for the calendar year: Jan. 1st - Dec. 31.
Memberships are renewed annually, beginning October 1st.

Payment Section:

Dues Categories. Please select your DUES category and any other list items that may apply, such as voluntary contributions. Total Dues to be charged shall appear in TOTAL section below. Credit card payments are processes via Square secure processing. Please see your TOTAL just above the Credit Card Section at the bottom of this form.*

Senior Membership Dues$145.00

Senior Membership Dues ($125 + $20 (Field Day Raffle Tickets, pick up at club by Sept. 1 ).

Auxiliary Membership Dues $25.00

Auxiliary Membership Dues.

Junior/Senior Membership Dues$25.00

Junior/Senior Membership Dues.

Junior Member Dues $5.00

Junior Membership Dues.

Additional Voluntary Member Contribution$ Free

Additional Voluntary Contribution (Earmarked for Club Improvements). Unlike most clubs, Our Club does not charge an initiation fee. The Club appreciates any financial help offered. Voluntary Contributions will help our club in good shape. We appreciate all you want to contribute. Thank you!

Additional Contribution to the Club

Total $0.00

Credit Card Processing via Square Secure Processing

Today's Date*