Read Membership Application ­ Please Print ­ (Leave Italics Blank) text version

Saugerties Fish & Game Club, Inc.

Established in 1884 ­ One of the oldest sportsmen's clubs in New York State Members Association of the National Rifle Association (NRA), New York State Rifle and Pistol Association, Inc. (NYSRPA)

PO Box 261, Saugerties, NY 12477

Membership Application ­ Please Print ­ (Leave Italics Blank)

Date of Birth: ___/___/______ (Age: ____) Date of Application: ___/___/_____ Name: ____________________________________________________________________________________ Mailing Address: ___________________________ Street Address: __________________________________ City: __________________________________________ State: _________ ZIP Code: ____________________ Home phone: (_____) _____-________ Cell Phone: (_____) _____-_______ Email: _________________________________ Work phone: (____) ____ -______ Occupation: ___________________ Employer: ______________________ SF&GC Member Sponsor Signature(s) ­ Only one is required : 1: ____________________________________________________ (Confirming Director) _________________ 2: ____________________________________________________ (Confirming Director) _________________ NRA/NYSRPA Membership is encouraged. NRA Membership # ______________ NYSRPA # ______________ List any NRA, DEC or related certifications, qualifications: (e.g. hunting/firearm instructor, etc.) __________________________________________________________________________________________ List any other shooting, sportsmen's or hunting clubs where you have membership: __________________________________________________________________________________________ I have interest in participating in one or more of the following committees: (check all appropriate)

[__] Archery [__] Black Powder (Muzzleloader) [__] High Power (Military) [__] Pistol [__] Trap [__] Buildings [__] Postings & Lands [__] Community Relations (Women & youth activities, DEC/NRA training, etc.) [__] Legislation/Political Action (Write or send letters, etc.) [__] Fish [__] Fur Bearer (Trapping and coyote, fox, etc.) [__] Newsletter [__] Security [__] Range (includes Range Safety Officers, range maintenance, etc.) [__] Upland Game (Pheasant, quail, rabbit, etc.) [__] Social/Kitchen (Dinners, etc.) [__] Turkey [__] Big Game (Deer, Bear, etc.)

Membership Meetings on the last Tuesday ­ January through November 168 Fish Creek Rd. ­ (845) 246-6695

[__] Migratory Game (Duck, geese, woodcock, etc.)

Have you ever been convicted of a crime that would prohibit your full use of the SF&GC facilities? [__] Yes [__] No I certify that I am a citizen of the United States and, that if admitted to membership, I will fulfill my obligations of good sportsmanship and good citizenship. SF&GC reserves the right of rejecting or accepting this applicant. By signature below, applicant acknowledges, understands and accepts these terms and agrees to abide by the SF&GC Bylaws and Rules. I acknowledge that all information provided on this application is true.

Signature: _________________________________________ Date signed:________________

Date received: ___/___/___ BoD interview: ___/___/___ Sponsors(s) conf.: ___/___/___ Date first reading: ___/___/___ Voted: ___/___/___ Date paid: ___/___/___ Amount paid: $_________ cash or chk# ________ (SF&GC 7/2008)

Contact the Membership Committee Chairman with any questions regarding this application

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