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Application

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.)



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.

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.

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