*All New Members MUST print out and mail in the application linked above,
You may, however, also fill out the form below just so you can purchase your membership option and pay your new member fee online by PayPal or Credit/Debit Card. Thanks!

Member Registration & Member Renewal Form

Name

First

Last

Member#

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone (H)

Phone (C)

Date of Birth *

Your Date of Birth

Confirm Email

There is an initiation fee of $100.00. In addition to the dues amount that must be sent in with each new application.
Membership Renewals must be received by May 1st to maintain current membership status.

PLEASE ANSWER THE FOLLOWING QUESTIONS:

(1.) Has your hunting license ever been revoked? *

(2.) Have you been convicted of any game or fish violations? *

If yes, please explain:

(3.) Are you willing to be a volunteer for a work day? *

(4.) What type of game do you hunt? *

(5.) Current Members: Please list the Association properties you hunted last season?

(6.) Current members, please list any problems you may have encountered last season and any recommendations you have to improve our Association.

IF YOUR PLAN TO PURCHASE BUTTONS FOR DEPENDENTS PLEASE FILL IN NAMES AND AGES OF UP TO 4 : ($25.00 Each)

DEPENDENT 1

(1.) Dependent Name

(1.) Age of Dependent

DEPENDENT 2

(2.) Dependent Name

(2.) Age of Dependent

DEPENDENT 3

(3.) Dependent Name

(3.) Age of Dependent

DEPENDENT 4

(4) Dependent Name

(4.) Age of Dependent

GUEST BUTTON (Limit One Guest) $50.00

By signing this application below, I certify that the information contained herein is true and correct, that LCH&FA officials are authorized to verify the information provided and I further agree to abide by the Game and Fish Laws and Regulations of the State of Mississippi and those of the Federal Government and to read and abide by the rules and regulations of the Leflore County Hunting & Fishing Association as outlined in the member handbook.. I also agree as a condition of membership and it is agreed by all of my guests, as a condition of allowing them to participate as a guest, that each member or guest does for himself, his heirs, executors, administrators and assigns, releases and forever discharges The Leflore County Hunting & Fishing Association and its officers and directors of and from any claim, demand, action or right of action, of whatever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death or property damage resulting or to result from any accident, incident, or event which may occur as a result of participation in hunting, fishing or any other activities whether by negligence or not. I further agree that I will bear full responsibility for my guests at all times both legally, physically and financially.

Description of Memberships, and Priviledges of each:

Upland Game- Hunting of upland game and Fishing (NO WATERFOWL HUNTING)

Limited Waterfowl - Hunting of Upland Game and Fishing, waterfowl hunting outside the Scatters. Waterfowl hunting in the Scatters, when in the company of an Unlimited member. Name added to waiting list for Unlimited membership.

Special Out-Of-State Limited -- Hunting of upland game, Fishing and limited waterfowl privileges. (May hunt the Scatters in the company of an Unlimited Member. No voting or guest privileges, and is ineligible for advancement to Unlimited status.)

Unlimited Waterfowl - Hunting of upland game and waterfowl, and Fishing on all properties

Fishing Only - Member and immediate family, or Guest, if wearing a Guest button. NO HUNTING PRIVILEDGES.$40.00

I Agree (Check Yes below) *

Signature *

Date: *

Comment