Southwind Outdoors

Online Application for Club Membership

P.O. Box 55112, Little Rock, AR 72215-5112
Fax: (501) 537-0522 | Email: info@southwindoutdoors.com
Tel: (501) 537-0400 or Toll Free (877) 537-0400

REQUIRED

Have you ever spoken with anyone from Southwind before?

If so, please tell us who you
have been speaking with
(if you don't remember just type "I don't remember")

Contact Information

Name:

Home Address:

Address Cont.:

City:

State:

Zipcode:

Since:

(MM/DD/YYYY)

Home Status:

Home Phone:

Name Home Phone
is Listed Under:

Cell Phone:

Email Address:

Confirm Email:

Please enter a mailing address
if it is different from your home address.

Mailing Address:

Address Cont.:

City:

State:

Zipcode:

Employment Information

Employer:

Employer's Address:

Address Cont.:

City:

State:

Zipcode:

Employer's Phone:

Type of Business:

Employed Since:

(MM/YYYY)

Position:

Department:

Supervisor:

References

Reference #1

Name:

Phone Number:

Reference #2

Name:

Phone Number:

Please answer the following questions.

Yes \| No --	1. Are you a member of the NRA?
Yes \| No --	2. Are you a citizen of the USA?
Yes \| No --	3. Have you been convicted of a felony?
Yes \| No --	4. Have you ever injured anyone while hunting?
Yes \| No --	5. Do you have difficulty controlling your temper?
Yes \| No --	6. Are you now on probation for any criminal offense?
Yes \| No --	7. Do you currently lease land for your own hunting?
Yes \| No --	8. Have you ever damaged private property while hunting?
Yes \| No --	9. Have you ever sued anyone for personal injury from any cause?
Yes \| No --	10. Have you ever accepted payment for injuries from any cause?
Yes \| No --	11. Do you agree to never accept payment as a guide on Southwind land?
Yes \| No --	12. Have you been fined for a serious conservation law violation?
Yes \| No --	13. Has any other hunting club refused to renew your membership?
Yes \| No --	14. Are you a member of any anti hunting animal rights group?
Yes \| No --	15. Can you read and understand this application without any help?
Yes \| No --	16. Are you a member of any group opposed to the US government?
Yes \| No --	17. Have you previously applied for club membership with Southwind or any club affiliated with AWA or Southwind?
Yes \| No --	18. Have you ever claimed compensation from anyone, for property damage or injury, resulting from a hunting accident?
Yes \| No --	19. Have you been treated for addiction to a controlled substance or alcohol within the past year?
Yes \| No --	20. Do you have any physical or mental disabilities which could place you or others at risk of injury where you and others are hunting?

Identification

Drivers License Number:

License Issued By:

Drivers License Expires:

(MM/DD/YYYY)

Weight:

lbs.

Height:

ft. in.

Hair Color:

Eye Color:

Skin Color:

Birthdate:

(MM/DD/YYYY)

Marital Status:

Describe breed, color & number of hunting dogs you will be using:

List all vehicles to be used while using club property.

Vehicle #1

Make:

Model:

Year:

Color:

4x4?:

License Plate Number:

State:

Vehicle #2

Make:

Model:

Year:

Color:

4x4?:

License Plate Number:

State:

Dependents

List all dependents (spouse and dependent children) who may accompany you on our land.
Qualified dependents must be listed as your dependents on your federal income tax return.
A signed indemnification agreement must be received for each dependent prior to their access
to club land, including infants.

Dependent #1

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Dependent #2

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Dependent #3

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Dependent #4

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Dependent #5

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Dependent #6

Name:

Gender:

Birthdate:

(MM/DD/YYYY)

Relation:

(ie. Daughter, Son, Wife, etc...)

Miscellaneous Information

Have you ever completed a hunter safety course?:

What State?:

What Year?:

What other hunting clubs are you NOW a member of?

Club's Name:

Year Joined:

What other hunting clubs are you a FORMER member of?

Club's Name:

Year Terminated:

Estimated number of days you will use club land for each:

Quail:		Pheasant:
Duck:		Goose:
Dove:		Grouse:
Prairie Chicken:		Squirrel:
Rabbit:		Coyote:
Raccoon:		Prairie Dog:
Elk:		Antelope:
Turkey (Gun):		Turkey (Bow):
Deer (Gun):		Deer (Bow):
Boar:

How many (estimated) days will you fish:
How many (estimated) days will you camp:

Please check any states that you want to hunt in:

Alabama:
Alaska:
Arizona:
Arkansas:
California:
Colorado:
Connecticut:
Delaware:
Florida:
Georgia:
Hawaii:
Idaho:
Illinois:

Indiana:
Iowa:
Kansas:
Kentucky:
Louisiana:
Maine:
Maryland:
Massachusetts:
Michigan:
Minnesota:
Mississippi:
Missouri:
Montana:

Nebraska:
Nevada:
New Hampshire:
New Jersey:
New Mexico:
New York:
North Carolina:
North Dakota:
Ohio:
Oklahoma:
Oregon:
Pennsylvania:
Rhode Island:

South Carolina:
South Dakota:
Tennessee:
Texas:
Utah:
Vermont:
Virginia:
Washington:
West Virginia:
Wisconsin:
Wyoming:

Please list your four (4) preferred counties in order of importance (1 being the most important):

#1:

#2:

#3:

#4:

How did you hear about us? (Name sponsor or existing member, if any.)

RELEASE OF LIABILITY, HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

I, the undersigned, in consideration for allowing me to become a member of both American Wildlife Association (AWA) and Southwind, and also for allowing me to engage in hunting and shooting activities upon land owned by other parties that have made their land available to AWA/Southwind members, agree to release AWA/Southwind, and all said landowners from all liability for any injury to me, regardless of the severity or manner in which the injury is sustained, and also I agree to waive all rights to make any claim against AWA/Southwind or the landowners they refer me to, for any property damage or loss which I sustain.

I am fully aware that hunting and shooting guns and bows are very dangerous and hazardous sports which contain inherent risks, including, but not limited to the risk of personal injury, including catastrophic injury, death or property damage. If I sustain injury or loss while on the above property, resulting from gunfire or arrows, whether fired by myself or other people, who I may or may not know, who they are or where they are, I agree to release AWA/Southwind and the landowners from all liability. Furthermore, I am aware that there are many other ways in which I can be injured or suffer property damage, while on the landowners property, and I assume full responsibility for my actions which may result in injury, death or property loss or damage.

I am aware of injuries, death and property damage which can result from tripping, stumbling, falling, slipping, and climbing, resulting from my own negligence, and lack of skill in moving and observing variations in terrain or weather conditions; or, surface or subsurface snow, ice, ruts, bumps, ground cracks, holes, swells, falling trees & branches, protruding tree roots, stumps, dead trees, unsafe deer stands, open wells, covered wells, steep banks, ditches, gullies, cliffs, electric fence, barbed wire fence, snakes, ticks, spiders, mosquitoes, parasites, bacteria, viruses, microorganisms, insects, ponds, rivers, creeks, roads, livestock, aggressive animals, and all similar things whether or not mentioned. All AWA/Southwind land has ticks, and I am fully aware these ticks can infect me with Lyme disease. I understand the seriousness of Lyme disease. I will not hold Southwind or the landowners responsible for any injury or damage I sustain from anything mentioned above since I fully agree that I am aware of the potential hazards, and my own negligence will be the only reason I could sustain injury or loss. I assume full responsibility for staying away from obvious hazards, and all objects that could harm me, whether natural or man made, which are incidental to operation of a hunting preserve, farm or unattended country property.

I understand there will be other people in the same vicinity where I will be, even though I won't be able to see them, they will have guns and bows, and be shooting and hunting. I understand that I may be shot by someone else, and if I am, I agree to waive my rights to recover damages from the landowner upon whose land I am on, and confine my damage recovery action to the individual that shot the bullet or arrow.

I am fully aware of the danger to my person and property, resulting from my presence in an area where hazardous conditions may exist. I am willing to assume all of these risks, and hold only myself responsible if I sustain injury, death or property loss, or I cause the injury, death or property loss of someone else.

I agree that it is not a necessity for me to hunt or shoot, and I do so voluntarily for my own personal pleasure and entertainment.

I have willingly agreed to release AWA/Southwind and the landowners they have referred me to, from all liability resulting from my actions, or the actions of other people, while I am on the landowners property.

I understand I am giving up important rights by contractually agreeing to not sue or make claim against AWA/Southwind and their affiliated landowners upon whose land I may be injured, killed or suffer property damage resulting from numerous hazards which may or may not involve guns or bows.

I understand there are many other places where I am free to hunt and shoot, where I would not be required to sign this release of liability, but I have freely chosen to hunt and shoot at the places where this release is required.

I also agree that I have been given the right to seek an attorneys opinion before signing this agreement , and if I have not done so, it is because I have chosen not to do so, and nothing has been said to me verbally or implied in any way, that an attorneys counsel is not necessary. I know attorneys should be consulted before contracts are signed, and this is a contract.

Rules of conduct agreed to by member
1. I agree that my guests and I will not arrive at any AWA/Southwind leased property, under the influence of alcohol. We will wait at least 2 hours for each drink 	consumed (maximum 8 hours), before we enter the property, and we will never consume any form of alcohol while on club property.
2. I agree to not discard any trash on any AWA/Southwind property, including all food wrappers, sacks, containers, cans, bottles. I will pick up all spent shells I can find. Everything carried onto the property by me and my guests, shall also be carried off by us, when we leave.
3. I agree to never enter any AWA/Southwind property, for any purpose, unless I have first made a reservation with the AWA/Southwind office, and received approval to hunt all game I want to hunt, and other activities I want to engage in., including hanging deer stands, camping, fishing. I will not engage in any unapproved activities.
4. I agree never to loan my Southwind ID , book, or online AWA Reservation password to any other person. I will report any lost materials to AWA/Southwind immediately.
5. I agree to provide AWA/Southwind with a complete and accurate harvest report within 48 hours after each and every day of hunting or fishing reserved.
6. I agree to notify AWA/Southwind before 8:30 AM if I do not intend to use land reserved, unless the decision to not use the land is determined in route to the land, in which case, I will notify club of my non use, immediately upon deciding to not use the property. I will pay all fees due if I fail to cancel before deadline.
7. I agree to not take any person to club property, unless I first receive club approval, and I obtain their signature on the AWA/Southwind hold harmless agreement.
8. I agree to follow any special requests made by landowners which are shown on their property description page, or which I am told about.
9. I agree to always display my AWA/Southwind vehicle identification tag by hanging on the rear view bracket whenever parked on or near club property.
10. I agree to read the AWA/Southwind member notebook rule section completely, and call the office for clarification of any questions before I make any reservations.
11. I agree to make sure that all of my guests, know and follow all AWA/Southwind rules, and if they violate these rules, I will immediately terminate the reservation, stop further use of the property, leave the premises, and promptly report the violation to AWA/Southwind with my harvest report.
12. I agree to never accept any form of compensation for professional guide services on land leased by AWA/Southwind.
13. I agree to pay $1000.00 a day to AWA/Southwind for all unauthorized use of their land. I will not hunt, fish, lease, rent or attempt to lease directly or indirectly, any land which AWA/Southwind has/had leased, while I am/was a member until at least 5 years has elapsed, after the expiration of the last AWA/Southwind lease, without prior authorization from AWA/Southwind. I know they do try to recover lost leases. My interference will jeopardize their ability to release, causing Southwind damages.
14. I agree to never drive on club land without prior permission from AWA/Southwind. I'll only drive on established roads, when dry, never when wet if ruts will be made.
15. I agree to pay any fees due AWA/Southwind on the day reservations are made, before the date reserved, unless a credit card is provided or credit approved.
16. I agree I will not be on any property before 12:01 AM or depart after 11:59 PM of the date reserved, without prior phone approval from the Southwind office.
17. I agree to not restrict or restrain AWA or Southwind from unlimited promotional use of all photos and film of hunters and game seen and taken from club property.

By checking the box below I agree that I have completely read this agreement, I understand it thoroughly, I fully agree with its content, and warning of potential hazards which may result from my physical presence upon land owned by parties to whom I have been referred by AWA/Southwind, for the purpose of hunting and fishing. I agree to release from liability, AWA/Southwind and all said landowners, and to assume full responsibility for any injury, death or property damage which I may sustain or cause during my visit to their property.

By checking the box below you are agreeing to the terms and conditions listed
above in the RELEASE OF LIABILITY, HOLD HARMLESS AND INDEMNIFICATION AGREEMENT.
You are also agreeing that you are who you say you are and that all of the
information provided is accurate. Checking the box below will be equivalent to
signing this application by hand and will qualify as your electroic signature.

Check this box if you agree to the above statement(s).

Misleading or false information given to obtain club membership will
result in revocation of club membership and forfeiture of money paid
upon verification of intent to deceive Southwind, AWA, and/or any
affiliated clubs.

The information submitted in this form is considered confidentialbr />and will not willingly be shared with anyone outside of Southwind.
However, this page is not encrypted and while it is not likely,
it may be possible for others to see the information you submit.

Southwind Outdoors Online Application for Club Membership

P.O. Box 55112, Little Rock, AR 72215-5112 Fax: (501) 537-0522 | Email: info@southwindoutdoors.com Tel: (501) 537-0400 or Toll Free (877) 537-0400

***REQUIRED***

Contact Information

Employment Information

References

Reference #1

Reference #2

Please answer the following questions.

Identification

List all vehicles to be used while using club property.

Vehicle #1

Vehicle #2

Dependents

Dependent #1

Dependent #2

Dependent #3

Dependent #4

Dependent #5

Dependent #6

Miscellaneous Information

Check this box if you agree to the above statement(s).

Southwind Outdoors

Online Application for Club Membership

P.O. Box 55112, Little Rock, AR 72215-5112
Fax: (501) 537-0522 | Email: info@southwindoutdoors.com
Tel: (501) 537-0400 or Toll Free (877) 537-0400

REQUIRED