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                        LONDONDERRY FISH & GAME CLUB, INC. ON-LINE MEMBERHSIP APPLICATION

E-mail Address: *
Membership Type: *
Date Of Application: *
Last: *
First: *
MI:
Address: *
City: *
State: *
ZIP:
Phone Number: *
NRA Membership No:
Auto License Plate No: *
Occupation:
Tell us about your Interests (check all that apply)Hunting-Large/Small Game/Varmints
Fishing/Fly Casting
Target Shooting-Rifle
Target Shooting-Pistol
Black Powder/Muzzleloading Firearms
Archery/Bowhunting
Sporting Clays/Skeet/Trap
Hunter/Bowhunter Education
Orienteering
How did you hear about the Club?A current member referred me
A friend referred me
Referral from a Website
Referral from a local Sports/Gun Shop
A Web Search
Attended an Event at the Club
Through Participation in a Hunter Education Program

TERMS AND CONDITIONS FOR MEMBERSHIP

Any person who presents him or herself for membership in the Londonderry Fish and Game Club, Inc., and signs the membership application, certifies with their signature that they meet the following terms and conditions: 1. That the member renewing or new member 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. That the member renewing or new member applicant has not been convicted of a felony or any other crime for which incarceration of more than a year resulted. 3. That the member renewing or new member applicant is not an unlawful user of and/or addicted to illegal drugs. 4. That the member renewing or new member applicant is not a fugitive from justice. 5. That the member renewing or new member applicant has not been adjudicated as mentally defective. 6. That the member renewing or new member applicant is not the subject of (defendant) a court order restraining activities of harassing, stalking, or threatening.7. That the member renewing or new member applicant has not been convicted of misdemeanor domestic violence. 8. That the member renewing or new member applicant has not renounced his or her United States citizenship and is not an alien illegally present in the United States. 9. That the member renewing or new member applicant is not a member of any organization, group, club or association whose purpose, goals and objectives contravene the bylaws, principles, goals or purposes of the Londonderry Fish and Game Club, The National Rifle Association or general principles of sporting firearms, Archery, hunting and fishing. 10. That the member renewing or new member applicant practices safe and ethical use of firearms and archery equipment. *

Yes. I certify that I am a person who meets the above requirements.
I do not meet the above-requirements.

LIABILITY WAIVER FOR CLUB USE.

By accepting membership in the Londonderry Fish and Game Club and making use of the facilities thereof, the member renewing or new member 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 intentionally caused injury or damage. The member renewing or new member applicant hereby acknowledges that the use, handling and operation of firearms, Archery equipment, arrows and live ammunition presents inherent risks of serious bodily injury and or death and therefore, agrees to abide by all safety rules promulgated by the LFGC membership and/or its Board and Officers. The member renewing or new member applicant further agrees to indemnify and hold harmless, the Londonderry Fish and Game Club, its Officers and Board of Directors from any and all liability arising from same. Additionally, The member renewing or new member applicant agrees to indemnify and hold harmless, the Londonderry Fish and Game Club, its Officers and Board of Directors from any and all liability arising from the actions of individual members or member’s guests. *

Yes. I acknowledge the aformentioned and agree.
No. Please withdraw my application for membership.
Place your initials in this box to serve as a signature *

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