Membership Form
Farmington Fish And Game Club, Inc.
P.O. Box 518
Farmington, New Hampshire 03835
![Text Box: Farmington Fish & Game Club, Inc.
PO Box 518
Farmington-NH 03835
Membership Application
(Name ____________________________________________ Date _____ / _____ / _________
Address __________________________________________ Phone ( ) _______ - ____________
City _____________________________________________ State _______ ZIP _________________
E-mail ___________________________________________ Date of Birth _____ / _____ / _________
[ ] New Member [ ] Renewal
_____ $ 5 Junior Membership (10 – 16 yrs)
_____ $30 Regular Membership (17 – 64 yrs)
_____ $15 Senior Membership (65 yrs or over)
_____ $50 Family Membership
(spouse and children under 17 - Please note names/DOB’s on back of form)
Have you, or any family member listed, ever been convicted of a crime that prohibits you from purchasing, possessing, or owning a firearm under state or federal law? YES NO (circle one) If yes, please provide a written explanation.
Have you, or any family member listed, ever been convicted of any fish and game violations resulting in the suspension of hunting and/or fishing privileges? YES NO (circle one) If yes, please provide a written explanation.
I, _________________________ , attest that all statements on this form are true to the best of my knowledge. I understand that if any statements on this form are found to be false, my membership may be terminated.
Signature ___________________________________________ Date __________ / __________ / __________](image1147.gif)
