Application for Membership:

Copicut Rifle Association

P.O. Box 3049

Westport, Ma. 02790

Procedure for Application:

1. Present this completed form with all appropriate fees to the Membership Secretary

2. Acceptance of application is contingent upon attendance of New Member Orientation

PLEASE PRINT

Name :( First) __________________________________ (Middle) _____________________ (Last) _____________________________

Address: __________________________________________________________________ State: ___________ Zip: ________________

Home Phone: (______) _______________________ Date of Birth: M: ______ D: ______ Y: _________

E-Mail: ______________________________________________________________________________________________________

NRA Membership# (required for all members) _____________________________ Exp Date: ______________Type:__________

G.O.A.L Membership# (required for all members) __________________________ Exp Date: ______________Type:__________

Do you have: FID Card (Y/N)? _____________ . License to Cary (Y/N)? ______________

FID #:___________________________________________ Class: __________ State: _______ Exp. Date: _____/________/_______

LTC #:___________________________________________Class: __________ State: _______ Exp. Date: _____/________/_______

Are you a citizen of the United States of America (Y/N)? ________________

Have you ever been convicted of a felony (Y/N)? ________________________

Are you a registered voter (Y/N)? ______________________________________

Please check off all of your interests:

Pistol ______ Education ______ Maintenance ______ Vintage Rifle ______ Junior Rifle_______

CMP________ NMC ______ High Power Rifle Team_______ Other ____________________________________________________

Are you willing to work on any of these committees (Y/N)? _________________

If NO, please explain: _______________________________________________________________________________________

Please list any other club memberships: _________________________________________________________________________

By signing this application I hear by confirm that all the above information is correct and true and to abide by all By-laws and Rules set forth

by the Copicut Rifle Association, and to respects it's Officers, Staff and fellow members at ALL times

Sponsor's Name (print): __________________________________________ phone :( )___________________

Signature of Applicant: ____________________________________________________________ Date______ /_______/________

DO NOT WRITE BELOW THIS LINE

Date of acceptance: _________________ Membership # _______________________________

Attended Orientation _______________ Date: _______/________/_______ Instructor: ___________________________________

 

PO Box 3049 

Westport, MA. 02790 

RELEASE AND INDEMNITY AGREEMENT 

Read carefully before signing 

I, _____________________, hereby release the Copicut Rifle Association (hereinafter referred to as the “Association”), It’s Officers, 

Directors, Members, the City of Fall River, Ma, Their agents and employees, and all other organizations affiliated with the association 

from any and all liability for loss, damage, cost, and/ or causes of action, including but not limited to all claims for bodily and personal 

injuries and/ or death, and/ or property damage arising out of my participation in or attendance at any firearms (rifle, shotgun, handgun, etc.) 

or archery safety or training course conducted on association property or arising out of my participation in or attendance at any organized 

shooting or archery competition at the association or arising out of my informal use of the associations facilities or my presence at such 

informal use by any other person. I specifically understand that said activities include but are not limited to the operation and use by the 

undersigned and/or other persons of firearms, ammunition, archery equipment, range equipment and related devices and materials. 

This release is given on behalf of myself, my heirs, successors, executors, administrators and assigns. 

Furthermore, I acknowledge that: 

A) Prior to any activity on the associations property which required me to handle, or use any handgun, rifle, shotgun, ammunition, 

archery equipment, range or related equipment, I have received instruction on the use of all such firearms and equipment to be used 

in the activity, including but not limited to firearms to be used in any safety or training course, and I fully understand the manufacturer’s 

instructions provided with each such item. 

B) I agree to hold harmless and indemnify the association, it’s officers, directors, members, their agents, employees, and all other 

organizations affiliated with the association from any and all such claims related to my participation in or attendance at any such activity 

and/ or the use of any such firearms, ammunition, or equipment. 

C) I understand that there are inherent risks involved in the use of firearms, ammunition, archery equipment, and related items. I freely 

assume and accept those risk and responsibility for their consequences. 

D) I hereby release the association, it’s officers, directors, members, their agents and employees, and all other organizations affiliated 

with the association from any and all liability for bodily and personal injury, death or property damage to myself or to any person or 

property resulting from the design, selection, installation, maintenance, construction, adjustment, supervision or use of any or all of the 

associations facilities and/ or the firearms, ammunition, archery and/ or range equipment used in such activities, including but not limited 

to any claim based upon negligence, breach or warrant, contract or other legal theory. I accept and assume for myself, my heirs and assigns, 

the full responsibility for any and all such damage, injury, or death that may result.  

E) This agreement is governed by the applicable laws of the Commonwealth of Massachusetts. If any part of this agreement is determined 

to be unenforceable, all other parts shall be given full force and effect. 

I, the undersigned, have read and understand this Release and Indemnity Agreement. 

Print Name: ________________________________________________

Signature: __________________________________________________       Date: ____________________

Witness Print Name: ____________________________________________ 

Witness Signature: __________________________________________        Date:_____________________