Membership Application Welcome to Custer Sportsmen’s Club! "*" indicates required fields Name* First Middle Last Date of Birth* MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Important Notes Memberships expire on 12/31/2023. Children (17 and under) are considered guests at CSC and shoot for free. There will be no “range fees” or “range pass” for 2023. Membership Type* I was a CSC member in 2022. I was NOT a CSC member in 2022. I do not know if I was a member in 2022. New 2023 Membership*Individual Adult $210.00Two Adults in Household $315.00Senior (60+) Adult $190.00Disabled Adult $190.00Active Military & LE $190.00Senior (60+) – Two Adults in Household $285.00Disabled – Two Adults in Household $285.00Active Military & LE – Two Adults in Household $285.00Lifetime Individual Adult $2,250.00HiddenOct-Dec 2022 Membership Oct-Dec 2022 Membership $20.00 HiddenOct-Dec 2022 Membership Oct-Dec 2022 Membership $30.00 Renewal 2023 Membership*Individual Adult $150.00Two Adults in Household $225.00Senior (60+) Adult $135.00Disabled Adult $135.00Active Military & LE $135.00Senior (60+) – Two Adults in Household $205.00Disabled – Two Adults in Household $205.00Active Military & LE – Two Adults in Household $205.00Lifetime Individual Adult $2,250.00Branch of service or agency* Second Adult in HouseholdName* First Middle Last Date of Birth* MM slash DD slash YYYY Additional Donations to CSC CSC General Fund Custer’s Junior High Power Rifle Team Custer’s Junior Rifle Program (Community Outreach) Donation AmountNo DonationDonation – $5Donation – $25Donation – $50Donation – $100Donation – $150Donation – $250OtherOther Donation AmountIn the field below enter another amount that you would like to donate. Total Acknowledgement of Custer Sportsmen's Club Rules* I/We agree to abide by Custer Sportsmen’s Club policies and rules. I understand these policies and rules are subject to change. Liability ReleaseI UNDERSTAND THAT FIREARMS ARE POTETIALLY HAZARDOUS OBJECTS THAT CAN CAUSE SERIOUS INJURY OR DEATH IF MISUSED. I AGREE THAT I WILL ASSUME FULL RESPONSIBILITY FOR ANY AND ALL INJURIES, LOSSES, OR DAMAGES WHICH MIGHT OCCUR TO ME, AND/OR GUEST, WHILE ON THE PREMISES OF THE CUSTER SPORTSMEN’S CLUB, AND TO THE MAXIMUM EXTENT ALLOWED BY LAW I AGREE TO RELEASE, INDEMNIFY, AND HOLD HARMLESS CUSTER SPORTSMEN’S CLUB, ITS MEMBERS, BOARD OF DIRECTORS, MEMBERS, AND AGENTS FROM ANY LIABILITY WHATSOEVER FOR INJURIES, LOSSES OR DAMAGES; I AGREE THAT I ACCEPT TOTAL RESPONSIBILITY FOR MY ACTIONS, AND I WILL INDEMNIFY AND HOLD CUSTER SPORTSMEN’S CLUB HARMLESS, TO THE MAXIMUM EXTENT ALLOWED BY LAW, FROM COSTS (INCLUDING LEGAL FEES), INJURIES, DAMAGES LOSSES, OR LIABILITY TO THIRD PARTIES FOR CLAIMS ASSERTED AGAINST CUSTER SPORTSMEN’S CLUB ARISING FROM MY CONDUCT, AND/OR THE CONDUCT OF MY FAMILY AND/OR GUESTS, WHILE ON THE PREMISES OF CUSTER SPORTSMEN’S CLUB. I FURTHER CERTIFY THAT I AM NOT PROHIBITED UNDER ANY FEDERAL OR STATE LAW FROM POSSESSING A FIREARM. 1. Participation. I am voluntarily participating in or attending activities at Custer Sportsmen’s Club that involve firearms. I understand that firearms are hazardous objects that can cause serious injury or death. I agree that I am responsible for my safety while participating in or attending activities at Custer Sportsmen’s Club and will take all necessary precautions to avoid injury; I am physically and mentally prepared to safely participate in activities at Custer Sportsmen’s Club; I will utilize appropriate safety equipment and obey Custer Sportsmen’s Club’s instructions and guidelines at all times. I certify that I am not prohibited under any federal or state law from possessing a firearm. 2. Release and Waiver. I assume all risks, whether known or unknown, foreseen or unforeseen, arising from participating in activities at Custer Sportsmen’s Club or being present at the Custer Sportsmen’s Club facility. I hereby release, hold harmless and agree to indemnify Custer Sportsmen’s Club, its agents, assignees, officers, directors, shareholders, employees, event staff, event volunteers, the owners of Custer Sportsmen’s Club and affiliates (collectively, the “Released Parties”) from all actions, claims, demands, suits, losses, liabilities, charges, expenses (including, without limitation, attorneys’ fees) of any nature whatsoever (including claims for personal, bodily, mental injury and economic loss) that arise from or are in any way related to my participation in activities at Custer Sportsmen’s Club or being present at the Custer Sportsmen’s Club facility. I execute this release on my own behalf and on behalf of my spouse, partner, guests, heirs, children, legal representatives, and anyone asserting legal rights on my behalf, and this release is intended to relieve the Released Parties of any responsibility for any injuries or damage sustained at Custer Sportsmen’s Club as a result of my actions. I agree to indemnify and hold Custer Sportsmen’s Club harmless to the maximum extent allowed by law for any other loss, liability, claim, damage or expense whatsoever (including legal fees) asserted against or incurred by Custer Sportsmen’s Club arising out of my conduct at Custer Sportsmen’s Club. I understand that if any portion of this Release is held invalid, I agree that the balance of this Release should continue in full force and effect. I warrant that I have the right to execute this Liability Release and Indemnification Agreement in my own name, that I have read the above Release in full prior to its execution, that I am fully familiar with its contents and that I intend to be legally bound hereby.Digital Signature* Digital Signature of Second Adult* Please press “Submit Payment” once to avoid being double charged.HiddenCredit Card*Card Details Cardholder Name