Membership Application Membership Application Questions? Contact Club President Brandon Williams at (315) 404-2816 or brandonwilliams311@yahoo.com Membership Type New MemberJunior Member (under 18) Personal Information Full Name (required) Date of Birth (required) Phone Number (required) Email Address (required) Mailing Address (required) City State Zip Code Sex MaleFemale Dues Information • 1st Year Dues: $150 • Junior Membership: $5.00 • Dues collection runs August 1st - October 15th ⓘ A $20 late fee applies after October 1st. Payment details will be provided upon approval. Waiver & Agreement I hereby apply for Club membership and agree to abide by the rules, regulations and bylaws of the Steuben Fish & Game Club. I further state that I have been made aware of this requirement and that any violation thereof may result in loss of membership and penalties. I understand the hazardous nature of firearm operation and acknowledge the risk of injury associated with the use of the shooting ranges. I agree to assume all responsibility for the safe operation and usage of any firearm or ammunition in my possession and that I will not hold the Club responsible in any manner for my actions that result in personal property damage or personal injury. I am a lawful citizen of the United States of America. I have read and agree to the above waiver and the rules, regulations, and bylaws of the Steuben Fish & Game Club. How did you hear about the club?