DUCKCREEK GUN CLUB MEMBERSHIP APPLICATION
MEMBERSHIP: ⃝ New ⃝ Renewal
⃝ Individual ⃝ Couple (husband/wife) ⃝ Family *
Annual membership dues for current NRA Members: Individual $50, Couple (both NRA Members) $65, Family (adults NRA Members) $85.
Annual membership dues for NON-NRA Members: Individual $80, Couple $125, Family $140
Not an NRA member? We can sign you up AND get you a $10 discount! A simple click on the link at left side of page will get you started.
NAME (please print) ____________________________________________________________________________
ADDRESS ___________________________________CITY/STATE______________________________________
EMAIL ADDRESS ____________________________________________PHONE____________________________
DATE OF BIRTH _____________________________________
EMERGENCY CONTACT _______________________________ EMERG. PHONE ____________________
QUESTIONS – CIRCLE ANSWER BELOW – If couple or family application, questions apply to everyone under membership.
1. Have you been convicted in any court of a felony? YES NO
2. Is there any reason that you are prohibited by law to be around and/or possess any type of firearm? YES NO
3. Have you been subject to a court order restraining you from contact with another person? YES NO
If applying for a Couple or Family membership, please list individually:
Spouse ______________________________________DOB____________
Dependent ________________________________ DOB ___________
Dependent ________________________________ DOB ___________
Dependent ________________________________ DOB ____________
*Family is defined as at least one parent and dependent children under the age of 18 that live at home or are full time students through age 25.
My submission of this form implies that I have read and understand this application and have read and understand DuckCreek’s General Release Waiver, and Safety Guidelines & Rules of the Field. I understand that DuckCreek has the right to limit membership and violation of any rules or false answers on this form could result in membership being terminated. To the best of my knowledge, I have answered all questions truthfully.
Signature _______________________________________________ Date: ______________________
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TO BE COMPLETED BY CLUB:
PHOTO ID TYPE _________________________ CHECKED BY __________________________
NRA MEMBER # ______________________________ EXPIRATION DATE _________________
NRA MEMBER# _______________________________ EXPIRATION DATE ________________
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