Falmouth Rod And Gun Club Inc.
91 Auburn Street, PMB #1240
Portland ME. 04103
(207) 797-0048
www.frandg.org
APPLICATION FOR MEMBERSHIP
Membership Type (Check one))
Regular (Individual)
Associate (Immediate family member of a regular member)
Annual Dues (Jan. 1 to Dec. 31)
$125
$10
Application Fee
$75
0
Total Due
$200
$10
THE PATH TO MEMBERSHIP:
1. Obtain a Sponsor who is a Member in good standing
2. Demonstrate to your Sponsor your ability to safely handle firearms
3. You Must be a member of the NRA
4. Complete your Membership Application in full
5. You and your Sponsor must present your application, with first year fees, for consideration at a Social or Business meeting, held the 2 nd
Monday at 6:30pm and 3rd Monday at 7pm of each month.
6. Participate in 1 workday. See Club website for dates and times.
7. Attend the Club Safety Orientation. See Club website for dates and times.
8. After completing the above attend the next Business meeting to be voted in and receive your Club Membership Badge.
PERSONAL INFORMATION:
Last Name: _______________________ First Name: _____________________ Middle: _____ Date of Birth ____/____/____ Age: _____
Residence Address:___________________________________________________________________________________________________
Mailing Address if different: ___________________________________________________________________________________________
Home Phone: ____________________ Business Phone____________________ E-mail: ____________________________________________
Citizenship: _______________ Occupation: ________________________ Are you willing to help with club activities?
Yes / No
Employer’s Name and address: __________________________________________________________________________________________
NRA Member #______________________Other Memberships or Club Affiliations Yes/No. If Yes, list________________________________
References: (NON-RELATIVES) with telephone numbers and addresses
1.
2.
3.
Sponsor (required): _______________________________
Sponsor’s Signature: ________________________________________
Have you ever been convicted of, or are you currently under indictment for, a felony? Yes___ No___. If yes, provide explanation on separate
sheet.
Are you legally entitled to own and possess a firearm? Yes ___ No___. If no, provide explanation on separate sheet
I certify that the information provided on this application is truthful. I agree to abide by the rules and by-laws of Falmouth Rod and Gun Club
Inc. (FR&G) as they may be amended. I understand that any criminal conviction requires immediate notification to a FR&G Officer and will
subject my application and/or membership to immediate review and appropriate action. In addition, in consideration of FR&G’s review of this
application for membership, if approved, I agree to indemnify, hold harmless, defend, and release FR&G as specified on page 2 of this
application.
I certify that I am not a member of any organization or group having as its purpose or one of its purposes the overthrow by force or violence the
Government of the United States of America.
Date: _______/________/_________ Signature of applicant: _______________________________________
Note: This is a 2-page application form. This application is not complete unless it is accompanied by a signed and witnessed copy of Page 2.
*Do not mail this application.
Club use only:
Directors Initials: (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____) (____)
Application fee paid: Yes____ No____. Annual dues paid:Yes____ No____. Application Accepted: Yes____ No____
Responsibility/Orientation Attended: Yes____ No____. Work Day Attended Yes____ No____. Membership Card Issued: Yes____ Date _____/_____/_____
Rev. 3/12
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Falmouth Rod and Gun Club Inc.
Falmouth Rod And Gun Club Inc.
91 Auburn Street, PMB #1240
Portland ME. 04103
(207) 797-0048
www.frandg.org
APPLICATION FOR MEMBERSHIP
INDEMNIFICATION, HOLD HARMLESS, DEFENSE, WAIVER,
RELEASE AND ASSUMPTION OF RISK AGREEMENT
In consideration of being accepted for membership and permitted entry to and/or use of “Premises” of Falmouth Rod and Gun Club,
Inc. (“Club”) for whatever purpose, including, but not limited to, use of firearms by him/her and/or another, and with full knowledge that
firearms are used and discharged on Club Premises, Applicant agrees to the following:
Applicant agrees to indemnify, hold harmless, and defend Club from any and all fault, liabilities, costs, expenses, claims, demands,
and/or lawsuits arising out of, related to, or in any way connected with, any and all actual or alleged acts or omissions of Applicant and
Applicant’s Guests in the course of Applicant’s and Applicant’s Guests presence on and/or use of Club’s range, buildings, facilities, and land
(together comprising “Premises”) including, but not limited to, Applicant’s and Applicant’s Guests use of firearms.
Applicant further waives for himself/herself and for his/her heirs, next of kin, assignees, personal representatives, administrators, and
executors any and all rights and claims for damages, loss, costs, demands, and any other actions or claims whatsoever, which he/she may have or
which may arise against Club (including, but not limited to, damage to Applicant’s and Applicant’s Guests property and/or any and all
illnesses, injuries, including mental or emotional distress or anguish, and other damages, including death, suffered by Applicant and Applicant’s
Guests) which may in any way whatsoever arise out of, be related to, or be connected with use of firearms on Club Premises by Applicant
and/or another.
Club shall not be liable for, and Applicant, on behalf of himself/herself and on behalf of his/her heirs, next of kin, assignees, personal
representatives, administrators, and executors, expressly releases Club and Club’s Officers, Directors, members, employees, and/or agents from
any and all such claims and liabilities including, but not limited to, claims of actual or alleged negligence on the part of Club, its members,
employees, and/or agents.
Applicant acknowledges and agrees that use of firearms is an inherently dangerous activity. Applicant expressly assumes the risk of
being on Club Premises where firearms are used; and Applicant further expressly assumes the risk of discharging firearms by whomever
discharged and the firing of live ammunition by himself/herself and/or another.
Applicant expressly agrees that this agreement by him/her is intended to be as broad and inclusive as permitted by law and that if any
provision of this agreement is held invalid or otherwise unenforceable, the enforceability of the remaining provisions shall not be impaired. No
remedy conferred by any of the specific provisions of this agreement is intended to be exclusive of any other remedy, and each and every remedy
shall be cumulative and shall be in addition to every other remedy now or hereafter existing at law or in equity or by statute or otherwise. The
election of any one or more remedy hereunder by Club shall not constitute any waiver of Club’s right to pursue other available remedies. This
agreement binds Applicant and his/her heirs, next of kin, assignees, personal representatives, administrators, and executors.
Applicant acknowledges and agrees that Applicant has read this agreement and he/she understands its terms and is executing this
agreement voluntarily. Applicant also acknowledges and agrees that he/she has read, understands, and will at all times abide by all range rules
and procedures and any other rules and procedures stated by Club.
APPLICANT:
Date: _______________________________
________________________________
Signature
____________________________________
Print Name
Witness:
________________________________
Signature
Rev. 3/12
____________________________________
Print Name
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Falmouth Rod and Gun Club Inc.