Gem City Outdoorsmen

	Please complete the following form to request membership.
	PLEASE NOTE: Your membership is not active until our Treasurer receives payment from you via check or money order.

	Full Name	eMail
	Address	City State Zip
	Phone Age D.O.B.
	Sponsor
	Occupation
	Type of Membership Regular $30.00 Senior $15.00 Family $45.00 (Includes Spouse and all Jr. Members 17 and under.)

	Family Memberships Please include the names of your family members:
	Spouse
	Child 1
	Child 2
	Child 3
	Child 4
	Child 5
	Special Intrests (Select as many as apply) Archery Trap Rifle Pistol Fishing
	As a member of Gem City Outdoorsmen I will conduct myself in a orderly manner and will heed any and all instructions given by a range officer while using the club facilities. I agree to indemnify and hold harmless from liability the Gem City Outdoorsman Club, directors, and trustees from any injury that I may incur while using the facilities of the club.
	I Agree to the above terms.