Membership App.

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Sippican Rod & Gun Club, Inc.
1997 / 1998 Online Membership Application

Check Class of Membership
New /Renewal $95.00 Family Mbr Additional $15.00 Senior Renewal $30.00

The period of membership is 12 months and expires on the last day of the month in which you joined / renewed. Memberships may be renewed within 120 days of expiration.

NAME:
ADDRESS:
CITY:
STATE: ZIP:
OCCUPATION:
DOB:
TELEPHONE:
E-MAIL/FAX:
FIREARMS PERMIT # EXPIRATION
NRA # EXPIRATION
G.O.A.L. # EXPIRATION

WHAT ARE YOUR INTERESTS?
RIFLE RIFLE PISTOL SHOTGUN/TRAP BLACK POWDER SMALL BORE
INSTRUCTOR ARCHERY STEEL PLATE & ACTION OTHER

HAVE YOU EVER BEEN CONVICTED OF ANY
FISH & GAME AND/OR FIREARMS VIOLATION? --- YES NO
(if yes, please explain)

By accepting membership I hereby agree to the following:

  1. To abide by the rules and by-laws of SIPPICAN ROD AND GUN CLUB, INC. the
  2. To conduct myself in a sportsperson like manner at all times.
  3. I understand that I am required to maintain my National Rifle Association membership.
  4. I also realize that I will be expected to participate in club activities, functions and work parties with a minimum of six being required annually in order to be eligible for any possible membership renewal discounts.
  5. I understand that disciplinary action imposed by the Board of Directors and General membership can include suspension or expulsion for violation of the safety rules and regulations of the corporation.
  6. I understand that range use privileges will not be granted until such time as I have completed a club run safety and range orientation course.

NRA PLEDGE
I certify that I am a citizen of the United States of America, that I am not a member of any organization or group having as its purpose the overthrow by force and violence of the government of the United States or any of its political subdivisions; that I have never been convicted of a crime of violence; and that, if admitted to membership, I will fulfill the obligations of good sportsmanship and good citizenship.

note: Please sign below after printing this form or when you meet with a club officer.

SIGNATURE: ____________________________________ DATE: ______________

Renewals
PLEASE - CHECKS ONLY - NO CASH ACCEPTED
MAIL TO:

SIPPICAN ROD & GUN CLUB
PO BOX 182, DEXTER LANE
ROCHESTER, MA 02770

FOR SRGC USE ONLY

MEMBERSHIP COMMITTEE

X _________________ X _________________ X _________________

RECOMMENDATION: ------- YES _____ NO_____
(if no, please explain)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Date application voted & accepted:____________________________________
Family ________ Single ________ Amount received _____________________
Participation Discount Allowed (Renewal Applications Only) Yes (___) No (___)
NRA ok ____________ Paid Check # _____________________________
Recommended by: X __________________ X __________________ SRGC html-fm 6-97