Felixstowe Rifle Club

Issue 22-01-18

Felixstowe Rifle Club

Walton Hall Range, Felixstowe

Application for Club Membership

Full Name:Date of Birth

Address:

Post Code:

How long have you lived at this address? years

If less than 1 year, your previous address:

Post Code:

Telephone: Mobile:

Email:

Place of Birth:

Name of current employer

Position:

Address:

Tel Number Service with current employer years

If less than 1 year, your previous employment details

Declaration by Applicants under section 21 of the Firearms Act 1968

Prohibited Persons

1. A person who has been sentenced to preventative detention or to imprisonment or to corrective training for a term of three years of more, or who has been sentenced to be detained in a young offenders’ institution in Scotland, shall not, at any time, have a firearm or ammunition in his possession.
2. A person who has been sentenced to borstal training, to corrective training for less than three years, or to imprisonment for a term of three months or more, but less than three years, or who has been sentenced to be detained for such a term in a detention centre or in a young offenders’ institution in Scotland, shall not at any time before the expiration of a period of five years, from the date of his release, have a firearm or ammunition in his possession.

I herby declare that I am not prohibited from possessing a firearm or ammunition by virtue of the above section. If my application is accepted, I agree to abide by the rules and regulations of the club at all times.

Signature:Date:

Do you hold a firearm or shotgun certificate?

If YES, Certificate no. Issued By:

Have you ever been refused or had a firearm or shotgun certificate revoked?

If YES, give reason:

Details of proposed shooting, please mark with ‘X’

.22 RimfirePistol Calibre CarbineBlack PowderAir Rifle/Pistol

Do you know any members of Felixstowe Rifle Club?

If YES, please state who:

Give full names and addresses of 2 referees who may be contacted by the club:

(These referees must have known you for a minimum of 2 years and must not be immediate family).

(1)

Name

Address

Tel No.

(2)

Name

Address

Tel No.

Do you know of any reason why you may be refused a firearm certificate?

If YES, give reason:

Enclose 2 passport size photographs. Print name on back of each photo

Applicant’s signature: Date:

If under 18, parent/guardian Name:

Parent/guardian Signature

Official Use Only

Applicants Name:

Date of Application:

Date of Committee Review

Membership TypeOrdinaryJunior Senior Blind/Disabled

Social

Provisional Membership

Approved /Refused

Sent / Received / Reminder / Comments
Police Letter (New applicant)
Referee 1
Referee 2
Passed to Committee
Offer of Membership
Subs Paid
Joining Fee Paid
NSRA Membership No.
Police Letter (Full member)
FRC Membership Card
Issued
Left/cancelled Membership
Leaver Notification to Police