Leflore County Hunting & Fishing Association

LEFLORE COUNTY HUNTING & FISHING ASSOCIATION

P.O. Box 790, Greenwood, Ms. 38930-0790

APPLICATION FOR NEW MEMBERS AND CURRENT MEMBER RENEWALS

Name______Member #______

Address______Date______

City______County______State____Zip______Phone______

Drivers License#______Employment______

*Memberhip Renewals must be received by June 30 to maintain current member status

Please select below the membership you wish to purchase:

See back of application for explanation of membership pricing.

( )Fishing Only--- $40.00 ______

( )Upland Game Only---$400.00 ______

( )Upland Game and Limited Waterfowl---$500.00 ______

( )Upland Game and Unlimited Waterfowl---$600.00 ______

( )Dependant Button(s)---$25.00 each(give name and age of each

dependant on back of this application. ______

( )Guest Button---$50.00(limit one) ______

( )Membership List---$5.00 ______

( )I would like to make a donation to the Avery Wood ______

Memorial Scholarship Fund.

Total Enclosed $ ______

Please answer the following questions:

(1)  Has your hunting license ever been revoked?______

(2)  Have you been convicted of any game or fish violations?______

(3)  Are you willing to be a volunteer for a work day?______

(4)  What type of game do you hunt?______

(5)  Current members, please list the Association properties you hunted last season:______

(6)  Current members, please list any problems you may have encountered last season and any recommendations you have to improve our Association:

(Attach a separate page if necessary)______
______
______

(7)  New member applicants please list three references: C-09

Name______City______Phone______

Name______City______Phone______

Name______City______Phone______

(Please complete page 2)

List the names and ages of all dependants you are purchasing a button for:

(1)______Age______

(2)______Age______

(3)______Age______

(4)______Age______

If you answered yes to question (2) on the front side, explain the violation you were convicted of and give the date: ______

By signing this application below, I certify that the information contained hereon is true and correct, that LCH&FA officials are authorized to verify the information provided and I further agree to abide by the Game and Fish Laws and Regulations of the State of Mississippi and those of the Federal Government and to read and abide by the rules and regulations of the Leflore County Hunting & Fishing Association as outlined in the member handbook. I also agree as a condition of membership and it is agreed by all guests as a condition of allowing them to participate as a guest, that each member or guest does for himself, his heirs, executors, administrators and assigns, release and forever discharge the Leflore County Hunting & Fishing Association and its officers and directors of and from any claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident, incident, or event which may occur as a result of participation in hunting, fishing or any other activities where by negligence or not. I further agree that I will bare full responsibility for my guests at all times both legally, physically and financially.

Signature______Date______

Description of dues structure and privileges of each:

FISHING ONLY---Member and Immediate Family Only, No guest privileges or hunting privileges.

UPLAND GAME ONLY---Hunting of upland game such as deer, turkey, doves, squirrels, rabbits, etc. No Waterfowl hunting at any time on any Association properties.

UPLAND GAME AND LIMITED WATERFOWL---Hunting of all upland game plus hunting of waterfowl on all Association properties outside of the McIntyre Scatters and waterfowl hunting on the Association’s 87.12 acres inside the Scatters if accompanied by and set up with a member who has Unlimited Waterfowl privileges. Also places the members name on the waiting list for Unlimited Waterfowl privileges.

UPLAND GAME AND UNLIMITED WATERFOWL---Hunting of all upland game and waterfowl on all Association leased and owned properties.

(All hunting memberships allow member access through the Associations owned property inside the McIntyre Scatters to access State owned property. Fishing is also included in all hunting memberships.)