Moonlite Hunting and Fishing Club, Inc.
P.O. Box 323 Burlington, Ky. 41005
Application for Membership
Name: ___________________________________________ Date of Birth: ___________
Address: ________________________________________________________________
City: ____________________ State: ________________ Zip Code: ________________
Home Phone #: ____________ Work Phone #: ____________ Wife’s Name: _________
Number in Family: ____ Are you a member’s son? ___ Employment / Trade: _________
Hunting and / or Fishing License Number: _____________________________________
Email Address: ___________________________________________________________
I am recommended for membership by: _______________________________________
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Please answer the following questions completely and accurately:
Are you a citizen of the United States? __________.
Have you ever been convicted of a felony? __________.
Have you ever been convicted of the unlawful use, possession, or sale of narcotic or harmful drugs? __________.
Have you ever been convicted of a crime punishable by incarceration by more then (1) one year? __________.
In any state or federal jurisdiction have you ever been convicted as an adult or adjudicated a youthful offender or delinquent child for the commission of (a) a felony; (b) a misdemeanor punishable by imprisonment for more then (2) two years; (c) a violent crime; (d) a violation of any law regulating the use, possession, ownership, sale, transfer, rental, receipt or transportation of weapons or ammunition for which a term of imprisonment may be imposed; (e) a violation of any law regulating the use, possession or sale of a controlled substance? __________.
Have you ever been convicted of a game law violation (hunting or fishing)? __________.
Have you ever been confined to any hospital or institution for mental illness? __________.
Have you ever appeared in any court as a defendant for any criminal offense (excluding non-criminal traffic offenses)? __________.
Are you now under any charge(s) for any offense(s) against the law? __________.
Are you now or have you ever been the subject of a restraining order or involved in a domestic violence charge? __________.
Has any license to carry firearms, permit to possess firearms, or firearms identification card issued to you under the laws of any state, territory or jurisdiction ever been suspended, revoked or denied? __________.
Are you currently the subject of any outstanding arrest warrant in any state or federal jurisdiction? __________.
If you answered “YES” to any questions TWO (2) through TWELVE (12), give details which must include dates, circumstances and locations. ________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________
(If necessary use a separate sheet of paper to complete.)
All information given by me is true and correct to the best of my ability. Any false entry on this application can mean the immediate revocation of my membership.
Signed: ___________________________________ Date: _________________________
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I am enclosing my initiation fee of $______ and my dues of $______ for the year _____. I desire to become a member of your club, and if accepted, I agree to abide by the By-Laws and I agree to promote the purposes of the Club which are:
Promote safe handling of firearms.
Assist the youth of our Club in sportsmanship, marksmanship and the art of safe hunting and fishing.
Abide by the Fish and Game Laws and do my best to discourage violations.
Encourage conservation of our natural resources, soil and wildlife and discourage pollution of our streams.
Cooperate with Conservation Officers.
I agree to abide by the rules and regulations of the Club which include but are not limited to:
I will take personal responsibility for the conduct and safety of my guests on Club property.
I will not handle sporting equipment on Club property if I am under sufficient influence of alcoholic beverages to endanger others.
I will attend the Club meetings.
I will conduct myself so as to promote good farmer / hunter relations.
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Are you now a member of any Sports Club? ______. If yes, list the name of the Club. ________________________________________________________________________
Have you ever been a member of such an organization? ________. If yes, list the name of the Club and the reason for leaving. ________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________.
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Initiation Fee of $________ and Dues of $________ for year ________ received on date _______________.
By Club Officer __________________________________________________________