NIPMUC ROD AND GUN CLUB, INC
 
Fiske Mill Road, Upton, MA 01568
P.O. Box 171, Hopedale, MA 01747
(508) 473-9778
 WWW.NipmucRodandGun.Com
 
Membership Application
 
Please fill out form, then print. All new membership applicants must submit application fee and dues IN PERSON at the monthly Membership Committee Meeting held every second Tuesday at 6:00 P.M..
Name
Date of Birth
Address
Phone
City
State
Zip
Occupation
Email Address
   
Dependent
Date of Birth
Dependent
Date of birth
Dependent
Date of birth
Dependent
Date of birth
Check all that apply:
F.I.D. Card
L.T.C.
N.R.A. Member
G.O.A.L Member
MA Bow Hunting Association Member
Identify club interests and committees you are willing to work with:
Archery
Range
Game
Kitchen
Grounds
Fishing
Raffle
Newsletter
Entertainment
Other
 
Have you ever been convicted of a felony?   If yes, please explain on back of page.
Membership: Family memberships consists of two adults and / or a single parent with any children under 18 years of age. A Junior member is any person 16 years of age or younger.
Single $90.00
Family $100.00
Junior $5.00
Life Member
Non-refundable Application fee (New members only): $50.00 .
Annual Membership renewals are due: October 1-31. Late Charges: $20.00 on renewals after October 31. Membership renewals expire December 31, after that date renewals will be subject to new membership obligations.
New $
Renewal $
Late Fee $
Donation $
All NEW members must attend (3) members meetings within 6 months of being excepted into the club. All NEW members must perform 8 hours of club service within the first year of being accepted into the club. All members are subject to Committee approval.

PENALTY FOR FALSE INFORMATION WILL RESULT IN TEMINATION OF MEMBERSHIP

Signature_____________________________________ Date___________________________