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*

Licenses

Have you ever had a hunting or a fishing license suspended or revoked?

Yes
No

Please provide details

NRA Membership Number

NRA Expiration Date

Concealed Weapons Permit Number

Concealed Weapons State

Concealed Weapons Permit Exp Date

How did you hear about us?

Spouse

First Name

MI

Last Name

Nicknmae

Cell Phone

Date of Birth

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.

Name

First Last

Date of Birth

Name

First Last

Date of Birth

Name

First Last

Date of Birth

Name

First Last

Date of Birth

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

Notes or comments

Applicant

Licenses

Spouse

Children

Liability

Event Calendar

Weather Conditions

Bylaws

SOP's