The Deerfield Fish & Game Club, Inc.

11400 Cruikshank Road, Deerfield, New York 13502
Mailing Address:  PO BOX 4828, Utica, NY 13504-4828

2008 Membership Application

[] $20.00 Membership - Supportive/Active Member            Donation $____ [] Range [] General

[] $20.00 Casual Membership - Only interested in the range and a place to shoot.

[] $30.00 Family Membership - Family means 2 memberships, Husband and Wife.

[] $20.00 Youth Membership - For 16 and 17 years olds.  Parent/Guardian signature required.

[] New Membership requires a member Sponsor: _______________________________

Name: _____________________________ Spouses Name: _________________________

Names and ages of children: _________________________________________________

Address: ___________________________________________________________________

City: _____________________ State, __________Zip Code: __________ - ___________

Home Phone: ______________ Cell Phone _______________ Date of Birth: ________

Email Address: __________________________ Occupation: _______________________

Check all that apply: [] Hunting [] Fishing [] Range

If you check Range, what kind of shooting [] Target [] Skeet [] Muzzle Loading

[] Other ____________________________________________________

Checks or money orders made payable to The Deerfield Fish Game Club must accompany this application. 
Mail to:  The Deerfield Fish & Game Club Inc., PO BOX 4828, Utica, NY 13504-4828

As a sportsman interested in Hunting/Fishing and or Shooting sports I pledge to support the
Constitution and bylaws of the Deerfield Fish and game club and will work with other club
members for the betterment of our sports and club.

Signature:  ______________________________________________ Date:  ______________

Our email address: deerfieldfishandgame@yahoo.com

To contact the president for information, email ellsworthc@adelphia.net

Emergency phone # 315-725-2379