New Membership Application

*
- Individual - Any person who is at least 18 years of age
- Family - Husband & Wife (or Significant other), or Unmarried head of household, plus dependents under 18 or under age 25 if attending an educational institution full time
- Student - 18-25 years old, copy of current semester schedule must accompany application
Applicant
(complete for all types)
First Name*
MI
Last Name*
NickName
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Cell Phone*
Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
Licenses
Have you ever had a hunting or a fishing license suspended or revoked?
- Yes
- No
Please provide details
Pro 2nd Amendment Group Membership Number (NRA,GOA, NAGR)
Pro 2nd Amendment Group Expiration Date
Date Format: MM slash DD slash YYYY
Concealed Weapons Permit Number
Concealed Weapons State
Concealed Weapons Permit Exp Date
Date Format: MM slash DD slash YYYY
How did you hear about us?
Spouse
First Name
MI
Last Name
Nickname
Cell Phone
Spouse Email (Required only for Family Memberships)
Date of Birth
Date Format: MM slash DD slash YYYY
Have you ever had a hunting or a fishing license suspended or revoked?
- Yes
- No
Please provide details
Children
If you are applying for a Family Membership, please list all children under 18 years of age. They can have an ID, but no gate access.
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
Liability
I agree that for good and valuable consideration received by me, I hereby release and discharge the Flagler Sports and Conservation Association,, Inc., (“Association”), its subsidiaries, agents, servants, officers, directors and employees from any and all liability resulting from claims, demands, actions or injuries or damages as a result of negligence or misconduct on the part of a member, guest, or from third parties or the Association or caused by me, members of my family, and my guests while on the Association’s property or while participating in any of the activities, programs or meetings sponsored promoted or conducted by the Association. This release and discharge of liability shall apply to all aspects of firearm and archery use and handling as well as supervision of shooters activities. I desire this release be construed by any Court to provide the broadest protection possible to those released. I agree to defend, indemnify and hold harmless the Flagler Sports and Conservation Association, Inc., (“Association”), its subsidiaries, agents, servants, officers, directors and employees, from any claims made by me any of my guests or family members. I have carefully read this release, know and understand the contents thereof and agree to all terms and conditions as set forth above.

By submitting this application I hereby authorize Flagler Gun Club to order a background check for the purpose of this application.
Full Name
Date
Date Format: MM slash DD slash YYYY
Notes or comments
Email

Applicant

Licenses

Spouse

Children

Liability

Event Calendar

Weather Conditions

Bylaws

SOP's