QUEENSLAND POLICE PISTOL CLUB INC.

PO Box 210

SHERWOOD, Q. 4075

President – Paul TRINDER, Mobile Tel No 0431 323 668, E-Mail –

Secretary - Mark WRANGELL, Mobile Tel No 0427 022 095 , E-Mail –

2017 Membership Registration Form

Surname:
Christian names (in full):
Date of Birth:
Residential address: / Postcode:
Home telephone:
Mobile phone:
Home email address:
Mailing address: / Postcode:
Occupation:
Employer:
Work/Business name
Work/Business address / Postcode:
Work telephone:
Work email:
Concealable Licence number: / Expiry:
Firearms Licence number: / Expiry:
SSAA Membership number: / Expiry:
Renewal advice / Closing date for renewals is 30 November 2017
Please make cheques payable to Qld Police Pistol Club Inc.
Electronic payments into Police Credit Union Account BSB: 704052 & Account 58825 – add S1 if transferring from a QPCU account. Please reference this payment with your own name. The Club financial year is 1 October 2015 to 30 September 2017.
Ordinary & Associate membership fee (pro-rata of $200) / $
Country & Unlicensed New membership fee (pro-rata of $100) / $
Working Bee Levy / $
TOTAL / $
Signature / ______Date / ______

QUEENSLAND POLICE PISTOL CLUB INC

PO Box 210, Sherwood Q, 4075

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APPLICATION FOR MEMBERSHIP

I, , hereby apply for membership of the Queensland Police Pistol Club Inc.

I am familiar with the relevant legislation, the constitution of the Club and the rules of any competition I may take part in. I agree to abide by the rules of the Club as laid down by the Constitution and By-laws.

If accepted by the Club, I realise that my membership will be subject to three months probation. During this probation period, I will be accompanied at all times when on the range by one of my nominees or a member approved by the committee. I will attend at least four official matches in the probation period.

I accept that in accordance with the Club By-Laws, I must become and remain a financial member of the Sporting Shooters Association of Australia (SSAA) as long as I am a member of the club to ensure my participation is covered by insurance.

I accept that in accordance with the Club By-Laws, during their first twelve months of membership, new members will only be authorised to purchase a revolver or a semi-automatic pistol which is approved for use in the Australian Police and Services Match competition.

I accept that I must attain Holster Proficiency to a standard suitable to the Club before I will be permitted to shoot without direct supervision.

I am aware that the Club's financial year ends on 30 September. I am aware that if I do not pay my Club dues by the nominated date or if I do not attend the required number of shoots as set by legislation, my membership shall be forfeited.

I am nominated by two current financial members named below, who accept responsibility for my conduct during the probation period.

I have completed the "Membership Registration Form" (overleaf) containing my personal particulars and I tender a cheque for the amount of $......

(N.B. Please note that applicants for a new licence may be required to obtain a Statement of Attainment which is a prerequisite of Weapons Act Safety Course Modules as required by the Weapons Licensing Branch prior to the issue of any licences.)

Signature: ......

1st Nominee: ...... 2nd Nominee: ......