Starting in 2019 all new members must apply at the club and attend a range safety orientation.
Deerfield Fish & Game Club, Inc.
Post Office Box 4828
Utica, New York 13504-4828
MEMBERSHIP APPLICATION FORM
Name: ________________________________________________________________ DOB: ___________________
Address: __________________________________ City: _________________ State: ____ Zip Code: __________
Email ____________________________________________ Required to receive range updates/other club information.
Cell Phone: _____________________________________ Home Phone: ___________________________________
 NRA # _________________________  RSO Date expires ____________________________
SELECT APPROPRIATE TYPE OF MEMBERSHIP
Membership cards require a photo. Photo must acompany the application. New memberships require a club member sponsor.
Membership (18 - 64 yrs old)  New $50.00  Renewal $30.00 Card No. XXXXXXX ___ __________
Senior Membership (65 yrs and older)  New $40.00  Renewal $20.00 Card No. XXXXXXX ___ __________
Youth Membership (16-17 yrs old)*  New $20.00  Renewal $20.00 Card No. XXXXXXX ___ __________
Active Military Membership  New $20.00  Renewal $20.00 Card No. XXXXXXX ___ __________
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: ____________________________
Sponsor's 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, photo and check may be mailed to The Deerfield Fish & Game Club Inc., PO BOX 4828, Utica, NY 13504-4828
Membership Cards can be issued at the Clubhouse. Your photograph will be taken for placement on the Membership Card at that time.
- ACCESS TO CLUB PROPERTY: Members are not authorized to be on the Club property without their membership card! NO CARD ASSUMES NO MEMBERSHIP.
- 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. 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. Each member must enter and exit using their own card.
- 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 as soon as the loss is discovered.
- 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: All new memberships paid after the September meeting will cover the balance of the current year and the following year.