Pinnacle Mountain Fish & Game Club, Inc. Application for Membership

    First Name   First_Name   Last Name   Last_Name
    Address   Address1   Address   Address2
    City  City   State  State   Zip  Zip
    Phone   Phone   Email   Email
    Occupation   Occupation
    Individual or Family Membership:   Membership   Name of Spouse   Spouse
    Are you a convicted Felon? Felon   Do you currently hold a fishing and/or hunting license? license
    Are you a member of another fish/game club?   another      If so, which Club(s)?   Club   
    Do you belong to the NRA?   
  If you answered "No" to either of above, please explain:
    Other affiliations such as "GONH"?
All applications must be sponsored by a current Club member with at least 3 years of membership.
Note: This requirement may be waived by the Board of Directors.
    First Name   sponsor_First_Name   Last Name   sponsor_Last_Name
    Address   sponsor_Address   Phone   sponsor_Phone
Sponsor`s Information [Please sign and date your answers on the back of this application]:
  How long you have known the applicant, and how did you become acquainted?
  Why do you believe the applicant would be a good member?

  All applications must have at least two references
    First Name   rec1_First_Name   Last Name   sponsor_Last_Name
    Address   rec1_Address   Phone   rec1_Phone
    First Name   rec2_First_Name   Last Name   sponsor_Last_Name
    Address   rec2_Address   Phone   rec2_Phone
Applicant: Please sign the statement below and submit this application with a $50.00 Initiation Fee, plus $30.00 for a single membership and $50.00 for a Family Membership. Applicants must be range qualified by the Club`s Range Officer and will be contacted to attend a range qualification session. Afterward, applicants will be notified of the time and date of when the Board of Directors will be conducting membership interviews.
  I hereby certify my willingness and ability to abide by the provisions of the bylaws of this club, and to observe all safety rules if accepted as a member.

Applicant`s Signature: ___________________________ Date: __________
Applications must be presented in PERSON at any Board of Directors Meeting which are held on the last Monday of every month at 7PM in the club house. Please direct any questions to the Club`s Secretary, Kip Degen either by telephone at: (603) 654-2795 or by email at: The Secretary will complete the following items.
    Check#   Check   Cash   Cash
    BOD Meeting Date   BOD   Reg Meeting Voted   Cash
       Tuesday February 21, 2017   -   click here to clear form