BUCKS COUNTY FISH AND GAME ASSOCIATION

NEW MEMBERSHIP

Membership is for ONE calendar year: January 1st thru December 31st or FIVE consecutive years.

This form does not entitle the holder to use the BCF&G facilities. You may only use the facilities as a member or guest of a current member.

The following procedure is the only way to become a member of the Bucks County Fish & Game Association.

1)Form must be completely filled out by prospective member and signed a valid ID is required. Two character references must be provided that are not related to prospective member

2)You must present yourself to the Club Secretary along with completed form and funds for the type of membership desired the day of the Range Safety orientation.

3)Applicants 18yrs of age and older must attend a mandatory Range Safety orientation the second Saturday of each month at 9:30am in the Club House.

4)Applicants must attend the General Membership meeting the 4thThursday of the month (November is the 3rd Thursday) at 7:30pm to take a Range Safety test and be accepted in to the club.

5)Applicants will be required to sign a WaiverRelease and Indemnification agreement.

6)Applicants submitting this application are providing their consent to the club to acquire a background check.

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1 YEAR 5 YEAR

Adult Male / Men 18 through 64 years of age in membership year (Juniors turning 18 must have an Orientation) / $195.00 / $450.00
Adult Female / Women 18 through 64 years of age in membership year / $170.00 / $350.00
Junior / Children 17 years of age & younger during the membership year / $30.00 / N/A
Family / Two adults with or without children under the age of 18residing at the same address or a single adult with children under the age of 18residing at the same address. / $260.00 / N/A
Senior / Men & Women turning 65 years of age during the membership year. Proof of age required / $150.00 / $270.00
Military / Anyone ACTIVELY serving in the Military. Proof Required. National Guard or Reservesnot included. / $0.00 / N/A

PLEASE PRINT CLEARLY

NAME / BIRTH DATE / SEX
M/F / OCCUPATION / RATE
$$$ / CLUB USE ONLY
CARD #

MAKE CHECK PAYABLE to BucksCounty Fish & Game Association. A $25.00 SURCHARGE WILL BE APPLIED TO ALL RETURNED CHECKS.

Member Information / SPONSOR INFORMATION / SPONSOR MEMBERSHIP ID #
Address / City/State / Name
County / Zip / City
Phone# / State/Zip
E-mail / Phone#
Total Payment / CHECK# / APPLICANTS SIGNATURE / DATE

BucksCounty Fish & Game Association, 1745 Turk Rd. Doylestown, PA 18901 2017MMS