Deerfield Fish Game Club, Inc.
Post Office Box 4828
Utica, New York 13504-4828
2018 MEMBERSHIP APPLICATION FORM
Name:________________________________________________ DOB: _____________ Card No. XXXXXXXX ______ , _____________
Address:____________________________ City:__________________ State:_____ Zip Code:________
Email Address:____________________________________ Required to receive range updates/other club information.
Phone  Cell  Home  Both (____) _____-_______________
SELECT APPROPRIATE TYPE OF MEMBERSHIP
Membership (18 - 64 yrs old)
 New $50.00
 Renewal $30.00
Senior Membership (65 yrs and older)
 New $40.00
 Renewal $20.00
Youth Membership (16-17 yrs old)*
 Renewal $20.00
As an applicant or renewing member, I hereby acknowledge receipt of the Club Rules & Regulations, and I hereby agree to uphold and abide by the same. I understand that my failure to uphold and abide by the Club Rules & Regulations will constitute grounds for immediate revocation of my membership.
Member Signature:___________________________________ Date: ____________
* YOUTH MEMBERSHIP REQUIRES THE SIGNATURE OF A MEMBER PARENT/GUARDIAN
As the Member Parent/Guardian, I hereby acknowledge that I am responsible to supervise the above sponsored
Youth Member at all times while on Club property and enforce compliance by the Youth Member of the Club Rules & Regulations.
Parent/Guardian Signature:_____________________________ Date: ___________
PAYMENT MUST ACCOMPANY THIS APPLICATION
Application and check may be mailed to The Deerfield Fish & Game Club Inc., PO BOX 4828, Utica, NY 13504-4828
Membership Cards require a photograph A headshot photo may be attached to membership application or emailed to ellsworthc@roadrunner,com a selfie or headshot photo in JPG format. Make shure full name in in email.
- ACCESS TO CLUB PROPERTY: Members are not authorized to be on the Club property without their membership card! NO CARD ASSUMES NO
- MEMBERSHIP CARD: Members must carry their membership card on their person and use the card while on club property. The membership card is the only way to access the Club property, clubhouse, and ranges. Once fully installed, the bump card readers on the ranges will be the only form of sign-in/sign-out accepted. Failure to use your card to access the club property, clubhouse, and/or ranges will constitute grounds for revocation of membership. Sharing or loaning of membership cards is PROHIBITED and will constitute grounds for immediate revocation of membership.
- LOSS OF MEMBERSHIP CARD: In the event a membership card is lost, it is the members responsibility to immediately report the same so that access may be suspended until a new card is issued. There is a $10.00 charge for replacement of a membership card and will require the member to appear for a new photo before printing. Lost membership card may be reported by email to: email@example.com; or by phone (315) 725-2379.
- RANGES: The Club ranges are for MEMBERS ONLY, GUESTS ARE NOT ALLOWED to shoot on the Club ranges.
- HUNTING: Membership does not provide an automatic right to hunt on the Club property. Any member who would like to hunt on Club property must submit a request in writing. Permission is limited and eligibility is determined by the Board. Please refer to the Club Rules & Regulations for the proper procedure.
- ANNUAL MEMBERSHIP TERM: Annual Membership runs from January 1st to December 31st of each year. Membership dues are due in December of the preceding year, with a grace period through April 1st of the current year. After the expiration of the grace period on April 1st any unpaid member will be dropped from the membership roster and will be treated as a new member (incurring a $20.00 initiation fee) when submitting a subsequent membership application form. NOTE: A new membership paid after September 1st will cover the balance of the current year and the following year.
# A passport style photograph can be sent in with renewal or new membership, name printed clearly on back. Email selfie or jpg head shot also works.