FCFF Membership Application – First Coast Fly Fishers

Affiliate Club Member

Membership Year

Highest) Directory Number

Address

Address Line 1

City

State

Zip Code

Email

Phone

Spouse/Partner Name

Emergency Contact Name

Emergency Contact Phone

List names & ages of fly-fishing children

Membership Directory Opt-In Choice

Yes
No

Check YES if you agree to have your name and email address included in the annual directory that will be distributed to members only, otherwise NO.

If you own a watercraft for fishing, enter the type and model or None

Retired?

Yes
No

Former or current occupation

Other Interests or Expertise

Rate your interest in the following (5 – Highest)

Photo (jpg preferred)

Drag & Drop Files, Choose Files to Upload

Please upload a photo of yourself, with or without a fish

Application and Release

I hereby apply for membership or renewal in the First Coast Fly Fishers (FCFF) Club of Jacksonville, Florida, Inc. I understand the inherent risk in participating in the activities of FCFF, including outings and meetings. I also understand that I am responsible for all costs of medical treatment and transportation incurred while participating in any FCFF-sponsored activity/event.

I, release, indemnify, and hold harmless, FCFF, its officers, directors and members against any and all claims for personal injury, disease, death and/or property damage or loss that may arise out of, or be connected in any way with any FCFF-sponsored activity/event. I assume the risk of participating in any FCFF-sponsored activity/event, including travel to and from the activity/event.

Signature

Clear Signature

Date

Membership Dues

Annual Club Membership is $100 and includes your spouse/partner and all family members under 18 years. There is no charge for Student or Lifetime memberships. Memberships are active from the payment date to the end of the selected Membership Year.

Payment Type (credit card is preferred)

Credit Card
Check
Cash

If paying by check, mail the check to:
First Coast Fly Fishers;
Membership Chairman;
PO Box 16260;
Jacksonville, FL 32245-6260

Select the time period of today's date

Nov. 1st to Jun 30th – $100.00
July 1st to Oct. 31st (Not for renewals) – $50.00