HavantRiflePistolClub

MembershipApplicationForm

Part1 -personaldetails(tobecompletedinfullbyallapplicants)

Full Name including title:
[Previous name(s) used]
Address:
[covering 5 years]
Date of Birth: Place of Birth: Nationality:
Occupation:
Email address:
Home Telephone:
Mobile Phone:

The ClubisrequiredbytheHomeOffice toverifyyoursuitabilitytobecomeamember.The Clubwill need to contact two responsible adults [not relatives], who have personally known you for more than two years, for written confirmation of your character.

Referee 1 [If a full club member: ask for signature to confirm recommendation]

Full Name
Address /email

Referee 2 [Do not complete if Referee 1 is a full member]

Full Name
Address/email

Areyouapersonwho isprohibitedunderSection21 of theFirearmsAct 1968, or otherwise, from

holding or possessinganyfirearmor ammunition?

(Pleaseaskfor explanatorynotes if youareunsure)Yes: No

Do you hold a current Firearms Certificate?Yes: No

If"yes"give number, expiry date and county of issue below:

Have youever been refusedaFirearmCertificate?Yes: No

Have you ever had a Firearms Certificate revokedYes: No

Areyoucurrently,or haveyoubeen, inthelastthreeyears,amemberof another shootingclubYes: No

If ‘Yes’ please give details:

Club name:
Secretary contact details/email:

Please ensureyouhavefilledinor markedallnecessaryboxes

Havant RiflePistolClub

MembershipApplicationForm-continued

Part2 –DECLARATION

(tobecompletedinfullby all applicants)

When applying for membership of Havant Rifle and Pistol Club you areasked to provide a range of personal data. Some of the data asked for is required in order to meet Home Office statutory requirements and therefore its provision is mandatory.The remainder is required for the routine administration of the club. Details relating to the retention, distribution and use of this information is outlined in the Havant RPC Data Protection Policy document, copies of which are available on the Club’s website or via a club official. A condition of membership is that you will keep your personal data that you have supplied to the club fully up-to-date and accurate. Signing this form, confirms your acceptance of these conditions.

IherebyapplyforProbationaryMembershipoftheHavantRifleandPistolClubanddeclarethatallthedetailsgivenin Part1 ofthisapplicationarecorrect.

IunderstandthatthejoiningfeeIam requiredtopayduringmyprobationaryperiodis forProbationary Membershiponly.

IunderstandthatduringmyprobationarymembershipperiodtheClubCommitteewillneedtocontactmynominated refereestoestablish mysuitabilityforcontinuedmembershipandpossibleelectiontoFullMembership.Ialsoagreeto themmakingotherenquirieswherenecessary.

IfelectedtofullmembershipIagreetoabidebytherulesoftheClubandtopaymyfirstannualsubscriptionuponelection.

I undertake thatthroughoutmyperiodasamemberoftheClubIwillnot,withoutspecificauthorityfroman Officer of the Club, remove from the Club premises any firearm or ammunition other than those possessed by me under the authority of a Firearm Certificate issued to me by a Police Authority

Signed Date

A passport type photograph should accompany this application.

Part3 -PARENT'S/GUARDIAN'S DECLARATION

(tobecompletedforallapplicantsunder18 yearsofage)

Iagreeto applyingforMembershipofHavantRifle andPistolClub.Ihavereadandacceptonhis/herbehalf, theconditionsoutlinedin thisapplication.Iconfirmthattheinformationgivenin Part1 is correct. No person under the age of 14 years shall have access to the range unless he/she is at all times under the supervision of a parent or guardian, or of a member appointed by his parent or guardian to supervise him/her.

Signed Parent/Guardian Date

Please waitbeforereturningtotheclubtoshoot until enquirieswith the Police are concluded.

TheSecretary willcontactyou when this has been completed.

ForClubuseonly.

Initial Police Check / Sent / Date Elected
Returned
Rules Sent / Member Informed
References / Sent 1 / Police Informed
Recd 1 / NSRA Informed
Sent 2
Recd 2