2008 MEMBERSHIP REGISTRATION FORM

Print and mail to the Miramichi Sportsmens Club
P.O. Box 4143, Stn. Douglastown, Miramichi, NB, E1V 7K8

Member Name______________________________________________
Possession or Possession/Acquisition Lic. #_________________________
Mailing Address______________________________________________
                         ______________________________________________
Postal Code__________________________
E-mail Address________________________
Phone Number________________________
Date of Birth: Day ______ Month ________ Year ______
For additional Family Members wishing to become members, list the following:
Additional Family Members (under 18) $10.00 each, Spouse $30.00 Extra
Spouse                Possession or Possession/Acquisition Lic. #                 $ Due
______            ____________________________________            _______
Family Members
______             ___________________________________              _______
______             ___________________________________              _______
______             ___________________________________              _______
______             ___________________________________              _______

Prime Member Dues:                                                                               $75.00

Total Due by Cheque or Cash                                                             _________

Please indicate Faction most interested                   Rifle         Pistol         Shotgun
Prime                                                                   __________________________
Spouse                                                                 __________________________
Family Members                                                   __________________________

If you need an "Authorization to Transport" permit for your restricted firearms, you need to call 1-800-731-4000 to obtain the proper form and once completed, it must be sent to the Chief Firearms Office, 615 Prospect St. West, Fredericton NB E3B 5H1. The club regulary e-mails our membership list to the above office.

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

A completed application form is required before your application will be accepted.

SIGNATURE:______________________________________         DATE:____________________
Issued__________________ Card___________ Key_____________ Transport____________

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