Use this form to contact us to get more information about  
joining our club   
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Your name:
Your email address:
Your phone number:

Or Mail: Matti tuck Gun Club
6250 Cox Ln.
Cutchogue N.Y.. 11935
631 734-4187                                          Mattituck Gun Club                                          
Membership Application     6250 Cox ln.(Cox Lane) Cutchogue N.Y.. 11935
May 7, 2011 (Revision 9)     

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.

  Name(Signature required)                            Physical   Address                                                         Telephone #

Please list other clubs that you have  1.------------------------------------------------------------------------------------------
belonged to and any offices held.       2.------------------------------------------------------------------------------------------            
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-__________

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.

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_________
Come Down to Meeting Month  before to meet other
members & secure a Sponsor regular club meeting,
of the month  
Application below to be filled out once you have a
    Physical Address of Matti tuck Gun Club                 
6250 Cox La   Cutchogue N.Y..  11935  
( Across the street from the Cutchogue town recycling center)