BADGE#_________

Whitinsville Fish and Game Club Inc

White Court PO Box 921

Douglas, MA 01516

Membership 2008

BADGE #______________

Please Circle: Sr. Membership (new or renew) JR/SR Junior Auxiliary

Last Name:_________________________________ First Name__________________________ MI____

Address:_______________________________________________________________________________

Email Address _________________________________________________________________________

ALL INFORMATION MUST BE FILLED OUT- NO EXCEPTIONS

Phone:________________________________

Date of Birth:___________________________

Email:____________________________________________________________________________

Sponsor (if new member)_____________________________________________Badge#__________

PAYMENT

MAKE CHECKS PAYABLE TO WHITINSVILLE FISH AND GAME CLUB INC

AMOUNT PAID___________________ DATE:_______________________

CASH_____________________________ CHECK#____________________

**RECEIVED BY:______________________________________________________

KEY#________________ (To purchase a new key $5.00)

COMMITTEE

Please Circle Two Committees to Serve during the 2008Year

House Birds Field Day

Grounds Archery Trap

Pistol/Rifle Bar Work Party

Kitchen Pond

*Club by laws require a minimum of (10 ) hours of work per year for the club. If not you will be assessed $20.00 extra on your following years dues.