NJSFSC INDIVIDUAL APPLICATION

Select type of membership desired. Send Check or Money Order
FOR TOTAL AMOUNT PAYABLE TO:

NEW JERSEY STATE FEDERATION OF SPORTSMEN'S CLUBS, INC.
P.O. BOX 10173, Trenton, NJ 08650

	INSURED MEMBER - $35.00 each Receives $1,000,000 excess liability insurance, membership certificate, and Federation's Monthly Newspaper --------------------------------------------------------------------	$_______
	INSURED HOUSEHOLD MEMBER - $30.00 each Receives INSURED MEMBERSHIP without newspaper --------------------------------------------------------------------	$_______
	SPORTSMEN MEMBER - $20.00 each Receives Federation's Monthly Newspaper, Membership Card --------------------------------------------------------------------	$_______
	SPORTSMEN HOUSEHOLD MEMBER - $5.00 each Receives SPORTSMEN MEMBERSHIP without newspaper --------------------------------------------------------------------	$_______
	Additional members in the same household can be listed on separate sheet of paper.
	Check if Emblem Decal is Required - $2.00 each	$_______
	Check if Emblem Patch is Required - $5.00 each	$_______

DONATIONS FOR THE NEW JERSEY STATE FEDERATION OF SPORTSMEN'S CLUBS LEGISLATIVE FUND

$_______

TOTAL

$_______

*Name_________________________________________________________
Address_______________________________________________________
City____________________________________State_________ZIP_______
County of Residence______________________
Date of Birth (MM/DD/YY) ___________________
Telephone_________________
Email address__________________________
Do You Have Homeowner's/Renter's Insurance?(circle one) Y / N
* Required - Insurance Company __________________________________
* Required - Policy #________________________________
Club Name(optional)_____________________________________________
Profession(optional)____________________________________________

* All information required unless otherwise noted