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. At some point in the application process, the applicant must pay 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: __________
The membership application process is described in detail in the Club`s publication "How to Apply for Membership", which is available at the Clubhouse on the last Monday of each month at 7:00 pm or via the Internet at:

    Check#   Check   Cash   Cash
    Lottery Selection Date   lottery_selection_date   Range Cert - Pass/Fail   range_certification
    BOD Meeting Date   BOD   Reg Meeting Voted      Wednesday February 21, 2018   -   click here to clear form   
       Wednesday February 21, 2018   -   click here to clear form