Possession or Possession/Acquisition License. #_________________________

Mailing Address______________________________________________

                         ______________________________________________

Postal Code__________________________

E-mail Address________________________

Phone Number________________________

Date of Birth: Day ______ Month ________ Year ______

Additional Family Members:
(Spouse & Children $40.00, under 16 free) Please list the following:

Name                Possession or Possession/Acquisition License.          Fee

______            ____________________________________            _______

______             ___________________________________              _______

______             ___________________________________              _______

Your Membership Dues:                                                                     $100.00
(After April 30, fee for previous members will be $125)

Total paid by cash or by cheque made payable to Miramichi Sportsmens Club       _________

Please indicate Faction most interested in:         Rifle ______   Pistol ______   Shotgun ______

Do you need an "Authorization to Transport" permit for your restricted firearms, YES ______       NO ______

By virtue of this application, the applicant acknowledges he/she has read this waiver and accepts it's contents. All members are obliged to read and follow the Club Rules and Safety Reminders. The Miramichi Sportsmens Club assumes no liability or responsibility for accidents that occur on its premises or for lost or stolen personal property of members or participants.