I, hereby of my own free will, absolve, release and hold free of any responsibility whatever, the Riley Conservation Club, Inc. or any officer thereof, from any injury or accident occurring to my person while engaged in any activity whatsoever while on the grounds of the Riley Conservation Club, Riley, IN, and forfeit herewith any claim for damages to me by my accident on said grounds. I agree to abide by the current rules of the Riley Conservation Club.

Signed: ___________________________________________________

Please Print Clearly

Name: ____________________________________________________

Address: __________________________________________________

City, State, & Zip: __________________________________________

Home Phone: (_________)____________________________________

Email Address: _____________________________________________

ð New Member or ð Renewal (check one)

Shooting disciplines / events you are interested in:

ð NRA High Powered Rifle

ð High Powered Rifle (other)

ð Rimfire Rifle

ð Muzzle Loader

ð USPSA Action Pistol

ð IDPA Pistol

ð Steel Challenge

ð NRA Action Pistol

ð Pistol (other)

ð Airgun

ð Silhouette

ð Archery

What activities do you participate in at the club?

ð Hunting

ð Fishing

ð Hiking

ð Shooting Range

ð Shooting Competitions

ð Other _______________________

What skills are you willing to contribute to the club?

ð Carpentry

ð Electrician

ð Bull dozing

ð Brush clearing

ð Match / Activity Organization

ð Other _______________________

ð I have included an additional $30.00 to participate in the member's gun giveaway (described on page 1 of this newsletter).

Complete the application and the survey above and send it, along with your annual dues, to the address on the front page of this newsletter. Please include a self-addressed stamped envelope for quick return of your membership card and gate key.

2010 Dues: *Regular dues - $70.00 *Over 60 years old - $35.00