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631 734-4187 Mattituck Gun Club
Membership Application 6250 Cox ln.(Cox Lane) Cutchogue N.Y.. 11935
May 7, 2011 (Revision 9) www.mattituckgunclub.com
Date: ____________ E-Mail Address:_____________________________ Telephone:_________________
Name:_________________________________________________________ Date of Birth:________________
Address:(No P.O.address)_______________________________________________________________________
City:__________________________________________ State:____________ Zip Code: ____________________
Place of Birth: ____________________________________________________ Age:(Minimum 18)_____________
Employer: ____________________________________________________ Occupation: _____________________
Annual Dues: $200.00 (March to February) Initiation Fee $200.00 (All monies must accompany application.)
Prorated Dues(first year) 1/4 dues from the month the application is voted in through February.
Sponsor:_________________________________________________________________________________
Name(Signature required) Physical Address Telephone #
Please list other clubs that you have 1.------------------------------------------------------------------------------------------
belonged to and any offices held. 2.------------------------------------------------------------------------------------------
3.------------------------------------------------------------------------------------------
Have you ever been rejected or dismissed from a club?------------
Have you ever been convicted of a misdemeanor , Felony , or charged with conservation violations? ________
My interests are: Rifle Pistol Archery Shotgun Pellet gun Fishing
Do you have a pistol licence? ______________ County_________ Verified____________________
Are you a member of NRA? ______ NYSE Rifle & Pistol assoc_______ Ducks Unlimited_____Other-__________
WILL YOU ACTIVELY PARTICIPATE IN WORK DETAILS AND FULFILL YOUR PROBATIONARY
REQUIREMENTS? (SEE BELOW)________
I hereby certify that all statements on this application have been completed by me and are correct to the best of my
knowledge. Upon becoming a member, I will abide by the Bylaws and Regulations of the club and conservation laws
of the State of New York.
Signed:____________________________________________________
Probationary Requirements (Completed within your probationary year)
1) Serve a 1 year probationary period.
2) Work 12 hours in work parties(or by arrangement) or pay $25/hour )Attend the Range use course and follow
Range Rules at all times.
4) Attend 2 meetings during your probationary year. Notify the chairman of the Membership Committee.
Probationary Members may shoot without taking the Range Use Course within their probationary year, ,but a Range
Officer , another member, or an Honorary member must be in attendance. A Key Card is available upon completion of
your probationary year.
Instructions: The applicant and Sponsor will meet with the Membership Committee at 7:30 p.m. before the regular
meeting. Upon approval by the committee, the application will be tabled for one month and voted upon at the next
meeting. The applicant should attend the next meeting.
Membership Committee Report: Accepted Rejected
Signature of Officer_____________________________________ Date_________
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