Decatur Gun Club
P.O.Box 3062
Decatur, Illinois 62524-3062
Application for NEW Membership
Name: ______________________________ Home Phone ( )__________________
Address: ____________________________ Work Phone ( )__________________
City:_______________________________ Other Phone ( )__________________
State:_________ Zip:_________________ E-Mail, etc.________________________
Date of Birth: _______________________ IL F.O.I.D.#_______________________
NRA#____________________________
I hereby apply for membership in the Decatur Gun Club, Inc., and agree that, if accepted, I will abide
by the By-Laws of the organization and will observe all safe firearms handling rules. I further affirm
that I have read, understand, and agree to be bound by the Full And Complete Release entered into
as a part of this application.
Signature of Applicant ________________________________ Date: _____________
Supplemental Information:
Occupation: ______________________________ Employer: ___________________
Special Skills/Interests: __________________________________________________
Shooting Interests: (check any that apply)
Skeet_____ Trap_____ Sporting Clays_____ Hunting_____ Other_____
Leagues: Skeet_____ Trap_____ Shooting Clinics: Skeet_____ Trap_____
Please provide your membership number in any of the following:
ATA____________ NSCA____________ NSSA _____________
Type of Membership and Dues:
Individual Family Student Life Senior Life (65+)
For NEW Membership Only (Circle One)
Full Year (S-O-N-D-J-F) $ 60.00 $ 80.00 $ 20.00 $ 1,000.00 $ 500.00
2/3 Year (M-A-M-J) $ 45.00 $ 60.00 $ 15.00
1/3 Year (J-A-S*-O*) $ 30.00 $ 40.00 $ 10.00
(*Full Membership may begin as early as September)
New Member Initiation Fee $ 10.00
Total Paid $
Signature of Sponsor Member __________________________ Date: _____________
Signature of Board Member ____________________________ Date: _____________
Signature of Life Member ______________________________Date: _____________
Approved, Board of Managers Meeting Date: _____________
Decatur Gun Club, Inc.
Range Rules for Safe Firearm Handling
1. Shotguns only (12 ga. or smaller) are allowed on DGC premises.
2. Target loads only of no more than 3-dram equiv. maximum powder charge and shot no larger
than size 7 ½ may be used on premises.
3. Shotguns must be unloaded and carried with the breach open at all times until shooter is
on-station, ready to call for the target. No more than two shells may be loaded into a gun at one time.
4. Eye and Ear Protection is REQUIRED to be worn by all participants.
5. Empty hulls may be retrieved after shooting is completed. NEVER retrieve empty hulls
beneath or in front of the low house chute or North of the sidewalk (in front of the field).
6. No person may participate in shooting activity if impaired by drugs or alcohol.
7. No spectators are allowed on fields during shooting.
Full and Complete Release
1. The Undersigned Participant, in consideration of being permitted to participate in shooting
activities and otherwise utilize premises of Decatur Gun Club, Inc. (DGC), hereby assumes full
responsibility for and risk of bodily injury, death or property damage while in or on DGC premises and
hereby releases, discharges, and agrees to hold harmless Decatur Gun Club, Inc., its officers,
directors, members and employees, the owners of the underlying real estate and lessees of the
premises and each of them, along with their officers, agents and employees, all referred to as
Releasees, from all liability to Participant and his or her personal representatives, next of kin, heirs or
assigns for all loss or damage or any claim of loss or damage on account of injury to persons or
property, whether caused by negligence of Releasees or otherwise, while participating in shooting
activities or utilizing DGC premises. Participant further agrees to indemnify Releasees and each of
them from any loss, liability, damage or cost Releasees may incur due to the presence of Participant
in or on DGC premises whether caused by negligence of Releasees or otherwise.
2. Participant affirms that he or she is of lawful age and under no legal restriction, has carefully
read the above Release, knows the contents thereof, and signs same as his or her own free act,
intending the Release to be irrevocable and effective perpetually into the future.
Dated:_______________ Signed:_________________________