Pro Shoot — Critical Performance Training

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number - Home

Phone Number - Mobile

Date of Birth

Do you have individual membership of the NRA?

If so, please give number

Do you hold a Firearm Certificate?

County Of Issue

Firearm Certificate Number

Firearms Certificate Expiry Date

Do you hold a shotgun certificate?

County Of Issue

Shotgun Certificate Number

Shotgun Certificate Expiry Date

Section 21 Declaration

It is an Offence for someone who is prohibited by section 21 to have a firearm or ammunition in his possession at any time. Section 21 applies to anybody who has been sentenced to imprisonment or to youth custody or detention in a young offender’s institution for three months or more. The period for which they are prohibited depends on the length of sentence if the sentence was longer than three years, the prohibition is for life. If the sentence was three months or more, but less than three years, the prohibition lasts for five years from the date of their release. It is an offense for a person to let, hire, give or lend a firearm to someone whom he knows or has reasonably ground for believing to be prohibited by section 21.

I declare than I am not a prohibited person under section 21 of the firearm act.

Previous Clubs

Have you ever been denied membership / quit / been suspended / removed or asked to leave a club?

Yes

Previous Clubs Continued

If you answered yes, please explain what took place and provide a name and contact details so we can contact should we need to make an inquiry.

Health

Do you suffer from any form of mental disorder or illness, or any serious health problems? E.g. Depression, Epilepsy, Heart problems etc. (Answering ‘Yes’ to this question will not prevent you from joining. It is more a case that we need to know of any issues so that we may take appropriate measures for members with health problems If YES, please give broad description.

Provision of contact details

Your email and home address is private to your account. We will only use your address for communications in respect of your membership of Pro Shoot Club and will never share any of your information with third parties. I give my permission for Pro Shoot Club to provide my telephone number and/or email address to other Club members and/or officials if requested

Media

When joining Pro Shoot Club, you agree that any photography taken whilst shooting and/or on the premises can be used in publicity material such as on our website or shooting press.

Reloaded Ammunition

I accept all responsibility for any reloaded ammunition (Reloaded by myself or knowingly someone else’s) that I use on the range should anything go wrong.

Signature

I state that the above facts are true and that I agree to abide by the Rules and Constitution, Regulations of Pro Shoot: Firearms & Shooting Sports and other Ranges. Should I commit any act on or off Pro Shoot Ranges likely to bring the club into disrepute, I understand that I may be expelled from the Club, and that any membership and range fees paid is nonrefundable.