E-mail Address: * Membership Type: * New Regular Membership - $120 New Junior Membership - $7.00 New Junior Membership with HE Endorsement - $7.00 New Senior Membership - 65+ $30.00 HUNTER ED NO. (for Junior members only seeking HE endorsement) Date Of Application: *
Last: * First: * MI: Address: * City: * State: * ZIP: Phone Number: * Cell Phone (optional) NRA Membership No: (NOTE: new members must submit NRA membership no within 30 days of club membership) Auto License Plate No: (Include Plate # and State) * Occupation: Tell us about your Interests (check all that apply) How did you hear about the Club? The Applicant certifies that by completing this application process, they are IN FACT the person named herein and meet the following terms and conditions: 1. That the applicant is not under indictment or information in any court, for a felony, or any other crime in which incarceration for more than a year could result. 2. Applicant has not been convicted of a felony or any other crime for which a sentence of incarceration for one year or longer resulted. 3. Is not an unlawful user of and/or addicted to illegal drugs; 4. Is not a fugitive from justice; 5. Has not been legally adjudicated as a mental defective; 6. Is not the subject of (defendant) a court order restraining acts of harassing, stalking, or threatening; 7. That the applicant has not been convicted of misdemeanor domestic violence; 8. Has not renounced his or her United States citizenship and is not an alien illegally present in the U.S; 9. Applicant is not a member of any organization, whose purpose, goals and objectives and aims counter the bylaws, principles, goals or purposes of the LFGC. 10. That the applicant practices safe and ethical use of firearms, archery equipment, and laws of the state and country. * By accepting offers of membership in the Londonderry Fish and Game Club the applicant acknowledges that he or she will use the club for RECREATIONAL purposes only and LFGC shall not be liable for personal injury or property damage in the absence of intentional deeds. The applicant further acknowledges that the use, handling and operation of firearms, Archery equipment, and live ammunition presents certain inherent risks of serious bodily injury and or even death. Applicant therefore, agrees to abide by, and not violate any and all safety rules promulgated by the LFGC membership and/or its Board and Officers. The applicant further agrees to indemnify and hold harmless, the LFGC, its Officers and Directors from all liability arising from same. The applicant agrees to further indemnify and hold harmless, the LFGC, its Officers and Directors from any and all liability arising from the actions, omissions or bad conduct of applicant�s prospective guests and/or invitees. * Please Place your initials in this box to serve as a signature * Verification Code :
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