Plattsburgh Rod and Gun Club Membership Application Form
(Includes applicant, spouse and children 21 and under) 

PLEASE NOTE - Not providing All of your information could delay your membership application.

OUR PLEDGE
We will NEVER sell, distribute or provide your contact information to any other person or entity.

Volunteers Wanted
To keep Membership/Range Fees affordable, we depend on volunteers to help with club activities and upkeep. Contributing just a few hours annually can have a substantial impact. We invite you to volunteer for activities such as Advertising, Event Planning, Open House Support, The Clinton County Fair, or our regularly scheduled cleanup days.

Attend Club Meetings
Although not required, we encourage members to attend three monthly meetings. By participating in a club meetings, you'll be among the first to learn about and provide your input on significant issues that matter to you.
 
Make checks payable to PLATTSBURGH ROD & GUN CLUB and turn in at the club OR mail it to

Plattsburgh Rod and Gun Club
Attn: Ian Dunbar
1254 State Route 9B
Champlain, NY 12919

FOR QUESTIONS, PLEASE CALL 518-593-9074

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RANGE DAILY FEES - USE OF RANGE REQUIRES A DAILY SHOOTING FEE

$8 for adults and $5 for students ($6 during non-heating season) (2024 - 2025)

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 ACKNOWLEDGEMENT

By signing below, I affirm that all statements made herein are true, and I authorize the designated officers of the Plattsburgh Rod and Gun Club (PRGC) or their appointees to verify the information on this form. I acknowledge the requirement to submit renewal membership applications, releases, and corresponding dues by October 31 each year. I commit to adhering to the PRGC by-laws, safeguarding PRGC property, and consistently exhibiting good sportsmanship. I am aware of the range rules and agree to comply with these and any future regulations established by the club. I also pledge to obey all State and Federal laws. I understand that any false statements or rule violations may lead to the termination of my membership. I accept responsibility for my safety, as well as that of my family members and guests. Additionally, I agree to compensate for any damages caused by myself, my family, my guests, or as a result of my firearms, ammunition, or vehicle.

RELEASE OF LIABILITY
 
In consideration of the rights and privileges extended to me, including the use of firearms and participation in other recreational activities at the property owned by Plattsburgh Rod and Gun Club (PRGC), 

I acknowledge receipt and sufficiency. I, for myself, my heirs, and assigns, hereby fully and forever release and discharge PRGC, its officers, directors, agents, employees, and assigns from any and all claims, demands, actions, causes of action, liabilities, damages, or judgments arising directly or indirectly from the exercise of the rights granted to me, regardless of any party's negligence, including PRGC. 

I expressly acknowledge to PRGC my understanding and acceptance of the inherent risks associated with shooting sports and other recreational activities on their premises, including but not limited to the risk of injury or death from firearms, acts of nature, animals both domestic and wild, and various road and land conditions, whether visible or not. Fully aware of these risks, I voluntarily agree to enter the premises and assume all risks at my own peril. 

HOLD HARMLESS

I also agree to indemnify and hold PRGC harmless from any claim, demand, liability, action, judgment, medical care or treatment costs, attorney’s fees, or any other expenses, whether asserted by me, through assignment, subrogation, by my heirs or assigns, or otherwise. I affirm that no representations or promises have been made to me by PRGC or anyone on their behalf to induce this release and indemnity, other than the rights and privileges associated with the shooting sports and other recreational activities.

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LAW ABIDING STATEMENT

I certify that I am a person of good repute; that according to New York State / US Federal Law it is legal for me to own or possess a firearm; and that if admitted to membership, I will fulfill the obligations of good sportsmanship and good citizenship.


Attention pistol shooters: New York State mandates a pistol permit. Permits from other states are not recognized. All pistol shooters are required to present a current permit upon request. 


FEDERAL PROHIBITED PERSONS (INCLUDING MARIJUANA USERS)

 
The Federal Gun Control Act of 1968 and the Federal Omnibus Consolidated Appropriations Act of 1997 make it illegal for a person who fits into any of the following categories to ship, transport, receive or possess firearms or ammunition. These laws prevent a state from issuing a concealed carry license/permit as it would be illegal for people who fit in these categories, by federal law, to own or possess a gun.
  • Persons who have been convicted in any court of a crime punishable by imprisonment for a term exceeding 1 year 
  • Fugitives from justice
  • Persons who are unlawful users of or are addicted to narcotics or any other controlled substances (including medical marijuana, see below)
  • Persons adjudicated as a mental defective or who have been committed to a mental institution (although relief may be available under the 2008 NICS Improvement Act)
  • Aliens illegally in the U.S.
  • Military veterans discharged under dishonorable conditions
  • Persons who have renounced U.S. citizenship
  • Persons convicted in any court of a misdemeanor crime of domestic violence 
  • Persons subject to a court order that restrains them from harassing, stalking or threatening an intimate partner or child of such intimate partner or person, or engaging in other conduct that would place an intimate partner in reasonable fear of bodily injury to the partner or child, with limited exceptions, provided the court order:

    • was issued after a hearing of which such person received actual notice, and at which such person had the opportunity to participate; and

      • includes a finding that such person represents a credible threat to the physical safety of such intimate partner or child; or
      • by its terms explicitly prohibits the use, attempted use, or threatened use of physical force against such intimate partner or child that would reasonably be expected to cause bodily injury.

New York law generally prohibits an individual from possessing if he or she:

  • Has been certified not suitable to possess a long gun by the director or physician in charge of a hospital or institution for mental illness

  • Has been convicted of a felony or “serious offense,” defined to include the following offenses under New York law, or the equivalent offense in another state: 
(1) illegally using, carrying or possessing a handgun or other dangerous weapon

(2) making or possessing burglar’s instruments

(3) buying or receiving stolen property

(4) unlawful entry into a building

(5) aiding escape from prison; certain kinds of disorderly conduct

(6) certain drug offenses or crimes involving sodomy or rape

(7) child endangerment; (8) certain crimes permitting or promoting prostitution

(9) certain kinds of stalking; and 

(10) certain violent or threatening crimes committed against a member of the same family or household, including assault, strangulation, menacing, harassment, and trespass.1
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    RANGE RULES

    I AGREE to follow all POSTED range Rules as well as all instructions by Range Officers while participating on any Public Line. 

    ELECTRONIC MEMBER COMMUNICATIONS

    All members agree to receiving Board Meeting Notices, Member Newsletters, and Important Club News via electronic distribution, primarily via their Email account. It is incumbent on the member to check and update their account on this website as required to maintain open communication channels between the Board of Directors and the General Membership.


    Email *
    Alternate Email
    Would Like to Volunteer my time *
    Required
    If you're interested in volunteering for an activity not mentioned above, or if you prefer not to volunteer, please indicate your choice.
    Type of Membership - Please Note All memberships are family memberships *
    First, Middle, Last name of Applicant *
    Date Of Birth *
    MM
    /
    DD
    /
    YYYY
    Do You have a Pistol Permit  *
    Required
    Pistol Permit Number
    Name of significant other: First, Middle, Last
    Please list all family members separated by a comma - First, Middle, Last, and Age (Only Family Members Involved in Range Activities, Volunteering, or Premises) 
    Email for - Spouse / Adult Children (18 - 21) - Please List ALL separated by a comma. 
    Primary Mailing Address *
    City *
    State *
    Zip Code *
    Telephone (Land Line)
    Cell Phone
    Preferred Methods of Contact: Phone (Voice), Phone (Text), Email *
    how long you've been a member of the Plattsburgh Rod and Gun Club? (Approx. Year) *
    Do you have a lifetime membership to the Plattsburgh Rod and Gun Club? *
    If a lifetime membership to the Plattsburgh Rod and Gun Club was offer, would you be interested?
    Preferred Payment Options - Please use the link below to make your payment by check or cash.

    Cash - In Person at the Range OR

    Check - Mail To 
    Ian J Dunbar
    CO - Plattsburgh Rod and Gun Club 
    1254 State Route 9B, Champlain NY 12919 
     *

    To Pay your 2024 - 2025 UNLIMIMTED Shooting Pass
    I AGREE WITH ALL FOLLOWING TERMS & CONDITIONS:  

    Please Type Name and last four numbers of your cell phone (Last Four will be used as your membership number on membership card).  if you read and understand all the terms and conditions. 
     *
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