REV 06/01/15
DATE RECEIVED (GSA USE ONLY) Click here to enter a date.
PROCESSED BY: (GSA USE ONLY) Click here to enter text.
www.guilfordsportsmen.org
NOTICE TO APPLICANT: THIS APPLICATION MUST BE SUBMITTED A MINIMUM OF TWO WEEKS PRIOR TO BEING VOTED UPON. ONCE COMPLETETED, SAVE THE FORM ON YOUR COMPUTER AND EMAIL A COPY TO ALONG WITH AN ATTACHMENT OF REQUIRED PICTURE ID's. THE FORM ENTITLED “GSA Membership Required Documents” (found listed with this form) SHALL BE USED TO PROVIDE PICTURE ID’s. A CHECK WITH DUES AND OBLIGATION PAYMENT SHALL BE MAILED TO: GUILFORD SPORTSMEN’S ASSOCIATION,C/O LOU SHAMAS, 58 ACORN DRIVE, WESTBROOK, CT. 06498‐2848 (PAYMENT STRUCTURE CAN BE FOUND ON PAGE 4 OF THIS APPLICATION)
Check one: New ☐ Re-Join ☐
NAME: Click here to enter text. DATE OF BIRTH: Click here to enter text. US CITIZEN: Choose an item.
STREET ADDRESS: Click here to enter text. CITY & ZIP Click here to enter text.
HOW LONG Click here to enter text. E‐MAIL ADDRESS (ALL COMMUNICATIONS ARE VIA EMAIL) Click here to enter text.
HOME PHONE: Click here to enter text. CELL PHONE: Click here to enter text.
OCCUPATION: Click here to enter text. EMPLOYER: Click here to enter text. HOW LONG: Click here to enter text.
MILITARY SERVICE: Choose an item. BRANCH: Click here to enter text. DISCHARGE TYPE: Click here to enter text.
MARRIED: Choose an item. CHILDREN NAMES AND AGES: Click here to enter text.
CT. HUNTING, FISHING, TRAPPING LICENSE: Choose an item.
STATE OF CT. CONSERVATION # FROM LICENSE: Click here to enter text.
HAS YOUR LICENSE EVER BEEN REVOKED OR SUSPENDED: Choose an item.
IF YES EXPLAIN: Click here to enter text.
DO YOU HOLD A CONNECTICUT PISTOL PERMIT: Choose an item.
HAVE YOU EVER BEEN DENIED A PISTOL PERMIT OR HAD ONE SUSPENDED OR REVOKED: Choose an item.
IF YES EXPLAIN INCLUDING DATES: Click here to enter text.
DO YOU POSSESS ANY TYPE OF HUNTER SAFETY OR FIREARMS OR ARCHERY TRAINING CERTIFICATES: Choose an item.
HAVE YOU EVER BEEN ARRESTED FOR OTHER THAN MOTOR VEHICLE INFRACTIONS: Choose an item.
IF YES, EXPLAIN INCLUDING DATES:
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HAVE YOU EVER BEEN CONVICTED OF A FELONY: Choose an item.
IF YES, EXPLAIN INCLUDING DATES:
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HAVE YOU EVER BEEN CONVICTED IN ANY COURT OF A MISDEMEANOR CRIME OF DOMESTIC VIOLENCE:
Choose an item.
ARE YOU SUBJECT TO A COURT ORDER RESTRAINING YOU FROM HARASSING, STALKING OR THREATENING ANOTHER PERSON INCLUDING YOUR PARENT, PARTNER OR CHILD: Choose an item.
IF YES EXPLAIN INCLUDING DATES: Click here to enter text.
ALL GSA MEMBERS MUST BE A MEMBER OF THE NATIONAL RIFLE ASSOCIATION (NRA).
ARE YOU PRESENTLY A MEMBER OF THE NRA?: Choose an item. IF YES, #Click here to enter text. IF NO, DISCOUNT NRA APPS ARE AVAILABLE FROM MEMBERSHIP CHAIRMAN.
LIST ANY OTHER SPORTSMEN’S ORGANIZATIONS THAT YOU CURRENTLY BELONG TO:
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PLEASE SELECT THREE COMMITTEES THAT YOU ARE INTERESTED IN SERVING ON. GSA BY‐LAWS REQUIRE EVERY MEMBER TO BE ON A COMMITTEE. PLEASE NOTE THAT THE GSA BOARD OF DIRECTORS RESERVES THE RIGHT TO ASSIGN A MEMBER TO A COMMITTEE OTHER THAN THOSE YOU HAVE SELECTED SHOULD THOSE BE FULL OR BECAUSE OF NEED.
1. Choose an item. 2. Choose an item. 3. Choose an item.
IMPORTANT!
IF ACCEPTED AS A MEMBER IN THE GUILFORD SPORTSMEN’S ASSOCIATION, I UNDERSTAND THAT IF I DO NOT HOLD A VALID CONNECTICUT STATE PISTOL PERMIT THAT I CANNOT LEGALLY TRANSPORT A HANDGUN TO OR FROM GSA CLUB PROPERTY. I UNDERSTAND THAT I MUST PRODUCE ANY PERMITS UPON REQUEST. I ALSO UNDERSTAND THAT ALL GSA COMMUNICATIONS TO MEMBERS ARE VIA EMAIL WITH FEW EXCEPTIONS. IF YOU DO NOT HAVE EMAIL, PLEASE PROVIDE EMAIL ADDRESS OF A COWORKER, RELATIVE OR FRIEND. I UNDERSTAND THAT ALL FEES MUST BE PAID IN FULL BEFORE I RECEIVE ANY CLUB KEY, ACCESS CARD, ETC. I UNDERSTAND THAT I AM ON PROBATION FOR MY FIRST YEAR. FAILURE TO ABIDE BY THE BY‐LAWS OF THE GSA MAY RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING DISMISSAL FROM THE GSA. I FURTHER UNDERSTAND THAT ANY FALSE STATEMENTS ON MY MEMBERSHIP APPLICATION ARE GROUNDS FOR IMMEDIATE REJECTION OR DISMISSAL. I FURTHER UNDERSTAND THAT A BACKGROUND CHECK WILL BE PERFORMED ON MY APPLICATION. IN ADDITION, SHOULD MY MEMBERSHIP BE TERMINATED FOR JUST CAUSE BY THE BOARD OF DIRECTORS DURING MY ONE YEAR PROBATIONARY PERIOD FOR NEW AND REJOIN MEMBERS, I WILL FORFEIT ALL MONIES PAID TO THE GSA INCLUDING ANY APPLICATION AND INITIATION FEES.
APPLICANT’S SIGNATURE: Click here to enter text. DATE: Click here to enter text.
Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. I Accept ☐
NAME OF GSA MEMBER SPONSOR (REQUIRED):
FOR GSA USE ONLY
DATE OF ACCEPTANCE Click here to enter text.AMOUNT PAID, DATE & METHOD Click here to enter text.
DATE OF DENIAL & REASON Click here to enter text.
Guilford Sportsmen’s Association
Required Documents
Please use the “GSA Membership Required Documents” form to attach documents.
This form can be found on the GSA Website where the main application is located.
Color photos need to be placed in the appropriate boxes in the “GSA Membership Required Documents” form.
GSA MEMBERSHIP APPLICATIONPage 1 of 4
Ø Passport Photo (This will be used for your membership card. Passport Photos can be obtained at CVS, Rite Aid, and Walgreens among other places. A actual photo is required (no scans).
Ø Driver’s License
Ø Pistol Permit
Ø Hunter Safety Certificate – Firearms
Ø Hunter Safety Certificate - Archery
Ø CT Hunting License
Ø NRA Membership Card
Current Year Fees & Obligations
One Time Initiation $750 + 10% State of CT Dues Tax
Annual Dues (Pro-rated) $225 + 10% Tax
Annual Environmental Fund (Pro-rated) $25
Annual Legal Fund (Pro-rated) $50
Annual Land Assessment (Pro-rated) $150
Non-Worked Hours $25 per hour
Members are obligated to sell Annual Raffle tickets per guidelines in effect
GSA Fiscal Monetary Year is July 1 thru June 30
GSA Fiscal Work Year is June 1 thru May 31
GSA MEMBERSHIP APPLICATIONPage 1 of 4