Name Date of Birth
Spouse / Other
Newsletter Mailing Address
City State Zip
Phone (Home) (Island) (Cell)
Firearms ID Card #MA License to Carry Firearms #
If you are retired, please enter your previous occupation.

 Please Check Areas of Interest

Archery Black Powder    
Boating Fishing
Hunting Pistol
Shotgun Shoot Skeet & Trap
Kids' Camp Jabberwocky Fishing Day    
Kids' Trout Tournament
Senior Citizens' Clambake
Hunter Education Courses
    Club Use      Date:
Type of Membership:
Total Dues Paid:
Initiation Paid:
Check, M.O Number:
Welcome Kit to Member:
Application to Mailroom:
Next Year's Dues:
Security Code:
Liability Release Signed:
Club Business - Newsletter/Meetings/Programs/Dinners/House & Grounds
Notes: If you have the wherewithal to assist in any of the above areas, please contact Bob De Lisle. Thanks.
Keep in mind that copies of the latest newsletter are always available in the clubhouse.
I, the undersigned, state that I have not been convicted of any hunting or fishing violations or any other
criminal offenses. Falsification of information on this application is grounds for automatic dismissal.

Applicant Signature Sponsor Name and Telephone



REGULAR: $200 / year

SENIOR: $100 / year (65+)


CALL: Bob De Lisle - (508) 627-3019 or
Cliff Meehan - (508) 627-8491

MAIL: M.V. Rod & Gun Club, PO Box 1799
Edgartown, MA 02539

COME BY: Applications at Clubhouse
every Sunday 12-5
Initiation fee and dues must be submitted with this application.
Fill in the form, then click here to print it.  Liability Release Form.  More Info.  Home Page.