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.#_______________________ 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____________ NRA____________ NSCA____________ NSSA _____________ Type of Membership and Dues: Individual Family Student Life Senior Life(65+) Full Year Early Bird (N-D) $ 45.00 $ 65.00 $ 20.00 $ 600.00 $ 300.00 Full Year (J-F) $ 55.00 $ 75.00 $ 20.00 $ 600.00 $ 300.00 2/3 Year (M-A-M-J) $ 41.25 $ 56.25 $ 15.00 1/3 Year (J-A-S-O) $ 27.50 $ 37.50 $ 10.00 Signature of Sponsor Member __________________________ Date: _____________ Signature of Board Member ____________________________ Date: _____________ Signature of Life Member ______________________________ Date: _____________ Approved, Board of Managers Meeting Date: _____________ _______________________________________________________________________________ Page 2 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:_________________________ |
|