Name: _____________________________________________________________________

Date of Birth:     ____________________________                          Age: ___________

Address: __________________________________________________________________________________________________

Telephone:      ___________                                    Fax:   ___________                               E-mail:  __________________________

Occupation:     ___________

D.E.C. Region # you reside in:    ___________

Type of Membership:                  Regular  ___             Supporting___                 Junior ___

Do you belong to any gun clubs?                     YES / NO            If YES, give name(s), address and phone number(s) 

____________________________________________________________________________________________

Have you ever been suspended from a Gun Club?          YES / NO            If YES, give name, address and phone number 

____________________________________________________________________________________________

Do you hold a guides license or have you ever been a guide (hunting or fishing)?          YES / NO            If YES please give brief details:

____________________________________________________________________________________________

Are hand guns licensed in your state?             YES / NO               If YES are you licensed?        YES / NO

Have you ever been convicted of a Game Law violation?               YES / NO

Please give the name and address of the government agency that controls the game laws in your state (if possible include the phone number): 

____________________________________________________________________________________________

Why do you want to become a member of  Deer Search? 

____________________________________________________________________________________________

Recommending DSI Member's Name (optional):

____________________________________________________________________________________________

Give the names/addresses/phone numbers of three (3) references:

1. ____________________________________________________________________________________________

    

2. ____________________________________________________________________________________________

    

3. ____________________________________________________________________________________________

    

Have you ever been convicted of a Game Law violation? YES / NO

                        print your name
I ……………………………………………………consent to have the Law Enforcement Division of the New York State Department of Environmental Conservation and the state of my residence make a recommendation concerning any history of law violations I incurred which might be incompatible with Deer Search activities.

____________________________________________________________________________________________

(signature)                                                                                                              (date)

Fees Due with Application (make check payable to Deer Search Inc.)                 

 $10.00 Application Fee PLUS  $15.00 Dues for Regular Membership (total $25.00)

OR  $10.00 Application Fee PLUS $25.00 Dues for Supporting Membership (total $35.00)

To be filled out by Chairman of the Membership Committee:

Date of reading:

Date of investigation:

Date voted on: