INDIVIDUAL & FAMILY MEMBERSHIP
MEMBERSHIP APPLICATION AND AGREEMENT
INSTRUCTIONS /
The Patriot Gun Club Membership Application package consists of the following pages:
- Membership Application and Agreement (1 page) (“Application”)
- Payment Authorization (1 page)
- Membership Application Checklist (1 page)
- Terms and Conditions of Membership (2 pages)
The Application has been set up as an Adobe fillable form. When you open the form in Adobe Acrobat Reader, it will highlight the fields to be completed. Do not fill in any blanks on the Payment Authorization at this time. The fields on the top of the Payment Authorization and Checklist should fill in automatically as you complete the Application.
Complete all fields in the Application that apply. Check the box indicating which Membership Type you desire. If you only desire an Individual Membership, you do not need to complete the “Family Members” section. If you desire a Family Membership, the “Family Members” section should be completed for all family members 21 years of age and older that desire to have full membership privileges, including afterhours access. Also indicate whether you desire to rent an optional private locker, and the size. There are very few large lockers. If you desire a large locker but one is not available at the time you join, your name will go on a waiting list for the large lockers and you will be given the small locker in the interim.
The Membership Fee is the same regardless of the type of Membership. You can change from Individual Membership to Family Membership, or vice versa, by sending an e-mail to and instructing us to make the change. The change will be effective on the first day of the following month, provided we receive your notice in enough time to implement the change to the recurring monthly payment charge.
Please sign the Application and return the entire Application package with a check for the Membership Fee payable to “Point Blank Range Mooresville” in the amount of $1,250 to:
Dave Driscoll
136 Cove Creek Road
Mooresville, NC 28117
The Membership Fee will be held in an escrow account at Aquesta Bank until the facility is complete and is open for business. Construction is scheduled for completion on May 18th and we hope to be open for business soon thereafter. We are planning a special evening event for the Club Members to show you the facility, but it is still too early to set that date. We will let you know as soon as possible. You will also be contacted by e-mail prior to opening to make arrangements for the Club orientation and schedule the NRA First Steps Pistol Class. At the Club orientation, we will ask you to complete and sign the Payment Authorization for the monthly dues, and pay the pro-rated dues for that month. You will also need to bring evidence of a firearms background check in your recent past. The background check can be evidenced by a Federal Firearms License, a NC Concealed Handgun Permit, a NC Pistol Permit, a law enforcement ID (if presently employed as law enforcement officer), or a copy of a receipt for a firearm purchase within the past six months.
We are excited to have you as a Member of Patriot Gun Club at Point Blank Range. Your early support of our vision of Patriot Gun Club shows that interest in a safe, clean and comfortable environment for shooting sports is high in the Lake Norman area.Based on our exhaustive review of existing ranges across the country, we believe Patriot Gun Club will set a new standard in the industry. Our first class Club Lounge will be impeccably furnished, with granite counters, leather seating, custom made card table and American Heritage 8’ billiard table.It will include attention to detail only found at private clubs of the highest caliber. We are fairly certain you won’t be disappointed. Our Shooting After Dark™ afterhours access will give Club members an opportunity to use the range based on your schedule, rather than ours. This access, together with all of the other amenities afforded Club members, makes Patriot Gun Club a fresh and exciting opportunity for anyone interested in the shooting sports.
Please feel free to forward this Application package to any of your friends or business associates who might also be interested in joining.
/ Patriot Gun ClubINDIVIDUAL & FAMILY MEMBERSHIP
MEMBERSHIP APPLICATION AND AGREEMENT /
The undersigned hereby applies to become a Memberof Patriot Gun Club at Point Blank Range ("PBR") and provides the following information as part of his or her application for membership:
Primary Member ______SS# ______-_____-______DOB ______/______/______
First NameLast Name
Home Address ______
Number and StreetCityStateZip
Mailing Address (if different) ______
Number and StreetCityStateZip
Home Phone ______Work Phone ______Cell Phone ______Email address ______
NC Driver’s License # ______Occupation ______Place of Employment ______
FAMILY MEMBERS______/____/____
NameEmail AddressDate of Birth
______/____/____
NameEmail AddressDate of Birth
______/____/____
NameEmail AddressDate of Birth
______/____/____
NameEmail AddressDate of Birth / EMERGENCY CONTACTS
______
First NameLast NameRelationship
______
Daytime PhoneEvening Phone
______
First NameLast NameRelationship
______
Daytime PhoneEvening Phone
Are you a United States citizen? Yes NoHave you ever been convicted of a felony? Yes No
Do you have a North Carolina Concealed Carry Permit? Yes NoIf yes: Number ______Expiration Date ______
Have you ever been in the military or law enforcement? Yes NoIf yes: Branch/PD ______Date ______
Are you retired from law enforcement or the military? Yes No If yes: Branch/PD ______Date retired ______
How did you hear about us? Newspaper Radio Drive By/Signage Mail/Flyer Internet search Website Referral
Which of the following products/services interests you: Handguns Rifles Shotguns Training/Instruction Class III Competition
Have you completed any NRA instructional programs? Yes No If yes, which ones? ______
MEMBERSHIP TYPEIndividual $55.00 monthly dues
Family $75.00 monthly dues / LOCKER RENTAL (OPTIONAL)
17” tall locker $8.00 per month
35” tall locker $12.00 per month
MEMBERSHIP AND PAYMENT TERMS
To establish and qualify for Membership, Member agrees to pay anup-front membership fee of $1,250.00 (the “Membership Fee”). The Membership Fee is a one-time charge andis non-refundable. Monthly Dues for the Membership selected are due, in advance, on the first day of each month. Dues for the month in which the membership commences shall be prorated. The Membership shall commence on the date PBR approves and accepts this Membership Application.
ACCEPTANCE AND AGREEMENT
By executing this Membership Application below, the undersignedacknowledges receipt of the attached Terms and Conditions of Membership, which can also befound at . If accepted for membership, the undersigned agrees to be fully bound by the terms thereof, as amended from time to time by PBR. The undersigned acknowledges and agrees that PBR reserves the right to change the Terms and Conditions of Membership and all benefits and amenities associated therewith at any time. The undersigned hereby authorizes the disclosure and release of information to PBR for the purpose of investigating the undersigned’s qualifications for membership and agrees that any third party may rely on this release. In the event of a breach of the Terms and Conditions of Membership by the undersigned, his or her guests, or his or her family members (if a Family Membership), the Membership may be terminated by PBR, and the Membership Fee and any prepaid dues shall not be refunded. The Membership may be cancelled by the undersigned at any time upon at least 15 days written notice. THE UNDERSIGNED AGREES TO RELEASE AND INDEMNIFY PBR AS SET FORTH IN THE TERMS AND CONDITION OF MEMBERSHIP.
______/____/_____
Primary MemberDate
/ Patriot Gun ClubINDIVIDUAL & FAMILY MEMBERSHIP
PAYMENT AUTHORIZATION /
Primary Member ______Individual Family Member ID# ______
First NameLast Name
Home Address ______
Number and StreetCityStateZip
PAYMENT SUMMARYMembership Dues$______Membership Fee Paid$______
Locker Rental$______1st Month Prorated$______
Total Monthly Dues$______Total Paid on Joining$______/ METHOD OF PAYMENT
Cash
Check # ______
Visa MasterCard AMEX Discover Card
Select a method for monthly dues payments and complete the necessary details:
AUTHORIZATION FOR ACH TRANSFERS
Account Type / Checking Account Savings Account
Financial Institution / Branch
Routing # / City
Account # / State
AUTHORIZATION FOR CREDIT CARD PAYMENTS
Card Type / Visa MasterCard AMEX DiscoverName on Card / ExpirationDate
Account # / Security Code
SEND PAYMENT RECEIPTS TO
Contact NameContact Email
The Primary Member listed above does hereby authorize Point Blank Range Mooresville LLC (“PBR”)to process payment for the monthly dues set forth above (as modified from time to time) and for any other charges due under the Terms and Conditions of Membership for the duration of my Membership by initiating debit entries to the account at the financial institution authorized above for ACH transfers or initiating charges to the credit card account authorized above for credit card payments, as applicable. This authorization shall remain in full force and effect until PBR has received WRITTEN NOTIFICATION from the undersigned of cancellation in such time, and in such manner, as to afford PBR and the designated financial institution a reasonable opportunity to act on it, WHICH SHALL BEAT LEAST FIFTEEN DAYS IN ADVANCE OF THE MEMBER'S NEXT PAYMENT DUE DATE.
______/____/_____
Primary MemberDate
/ Patriot Gun ClubINDIVIDUAL & FAMILY MEMBERSHIP
MEMBERSHIP APPLICATION CHECKLIST
FOR INTERNAL USE ONLY /
Primary Member ______Individual Family Member ID# ______
First NameLast Name
Home Address ______
Number and StreetCityStateZip
Primary Member / Verified / DateCopy of Drivers License / By: ______/ Date:______
Background Check Documentation Type ______Expiration Date ______/ By: ______/ Date:______
Membership Fee and Prorated Dues Received / By: ______/ Date:______
Set-up monthly dues payment / By: ______/ Date:______
Membership kit delivered to Member / By: ______/ Date:______
Club Orientation completed / By: ______/ Date:______
First Steps Pistol Course completed / By: ______/ Date:______
Biometric ID Set-up ID #______/ By: ______/ Date:______
Family Member Name: ______E-mail: ______/ Verified / Date
Copy of Drivers License / By: ______/ Date:______
Background Check Documentation Type ______Expiration Date ______/ By: ______/ Date:______
Club Orientation completed / By: ______/ Date:______
First Steps Pistol Course completed / By: ______/ Date:______
Biometric ID Set-up ID #______/ By: ______/ Date:______
Family Member Name: ______E-mail: ______/ Verified / Date
Copy of Drivers License / By: ______/ Date:______
Background Check Documentation Type ______Expiration Date ______/ By: ______/ Date:______
Club Orientation completed / By: ______/ Date:______
First Steps Pistol Course completed / By: ______/ Date:______
Biometric ID Set-up ID #______/ By: ______/ Date:______
Family Member Name: ______E-mail: ______/ Verified / Date
Copy of Drivers License / By: ______/ Date:______
Background Check Documentation Type ______Expiration Date ______/ By: ______/ Date:______
Club Orientation completed / By: ______/ Date:______
First Steps Pistol Course completed / By: ______/ Date:______
Biometric ID Set-up ID #______/ By: ______/ Date:______
Family Member Name: ______E-mail: ______/ Verified / Date
Copy of Drivers License / By: ______/ Date:______
Background Check Documentation Type ______Expiration Date ______/ By: ______/ Date:______
Club Orientation completed / By: ______/ Date:______
First Steps Pistol Course completed / By: ______/ Date:______
Biometric ID Set-up ID #______/ By: ______/ Date:______
/ Patriot Gun Club
INDIVIDUAL & FAMILY MEMBERSHIP
TERMS AND CONDITIONS OF MEMBERSHIP /
The following Terms and Conditions shall apply to all Memberships issued by Point Blank Range Mooresville LLC (“PBR) for membership in Patriot Gun Club at Point Blank Range. Any reference to “you” or “your” shall refer to the Primary Member identified on the Membership Application and Agreement (the “Application”) for such Membership. Any reference to “family members” shall mean the Primary Member’s immediate family members entitled to membership benefits under a Family Membership, as set forth herein. Any reference to “Members” shall mean the Primary Member and any of his or her family members 21 years of age or older entitled to membership benefits under the Family Membership.
- MEMBERSHIP REQUIREMENTS. No Application for membership shall be effective until: (a) the Application is completed and signed by the Primary Member and submitted to PBR with the required Membership Fee, (b) the first month’s pro-rata dues are paid in full, (c) a Payment Authorization is signed and delivered to PBR providing for payment of the monthly Membership dues, (d) the Primary Member (and each family member21 years of age or older desiring Club privileges, in the case of a Family Membership) provides evidence that they are qualified to purchase a handgun (i.e., North Carolina Concealed Handgun Permit, North Carolina Pistol Purchase Permit, law enforcement ID, a recent receipt for the purchase of a firearm), and (e) the Application is approved andaccepted by PBR. Access to the Club Lounge will only be available to Memberswho have completed the Club orientation. Access to the Range after normal business hours will only be available to Members who have successfully completed the NRA First Steps Pistol course taught by PBR’s NRA certified instructors. The tuitionforthe NRA First Steps Pistol course is waived for Club Members. PBR reserves the right to approve or reject any Membership Application.
- MEMBER’S RIGHT TO CANCEL. You may cancel the Membership at any time by sending written notice to PBR as provided herein. If the notice is received on or before the 15th day of any month, the cancellation shall be effective as of the last day of such month. If the notice is received after the 15th day of any month, the cancellation shall be effective on the last day of the next month. The Membership Fee and any prepaid monthly dues shall be earned in full upon receipt and shall be non-refundable in the event of your cancellation of the Membership or termination of the Membership by PBR for any reason.
- PBR’S RIGHT TO TERMINATE. PBR may terminate your Membership at any time for failure to pay the applicable Membership dues or following any breach or violation of these Terms and Conditions or other Rules of the Club by you or any of your family members or guests, or for any conduct which, in the opinion of management of PBR in its sole discretion, is prejudicial to the welfare, good order, and character of the Club,by sending written notice to you.
- CHANGES IN THE TERMS AND CONDITIONS OF MEMBERSHIP. PBR reserves the right, in its sole discretion, to discontinue operation of the Club or to modify these Terms and Conditions of Membership, to sell, lease or otherwise dispose of the Club facilities in any manner whatsoever and to any person whomsoever, to add, issue, modify, or terminate any category of Membership, to discontinue operation of the Club facilities, to limit use of the Club facilities, to convert the Club into a member-owned club,and to make any changes to the Membership benefits at any time. Such changes shall be effective on the date such revised Terms and Conditions of Membership are posted to the PBR web-site or as otherwise communicated to the Members. Any such changes shall be binding on you on the effective date of the change.
- CHANGES IN THE MEMBERSHIP BENEFITS. PBR reserves the right to add, eliminate or change any published Membership benefit or amenity at any time and from time to time, in its sole discretion. The Membership benefits at any time shall be as posted on PBR’s web-site or as otherwise communicated to the Members. Such changes shall be effectiveon the date such revised Membership benefits are posted to the web-site or communicated to the Members.
- FAMILY MEMBERSHIPS. A Family Membership shall grant membership privileges to the Primary Member identified on the Application and his or her spouse and unmarried children under the age of 26 living in the Primary Member’s home or attending school on a full time basis. Any such children 21 years of age or older shall be required to meet the same conditions of membership and shall have the same privileges as the Primary Member; any such children under the age of 21 shall have limited privileges as determined by PBR, including limitations onafterhours access. A Parent/Guardian Release of Liability must be signed and on file with PBRfor children under 18 years of age prior to their use of the Range. Any children in your Family under 18 years of ageshall be allowed to accompany the Primary Member or his or her spouse to the Club Lounge or Range, provided they remain under their direct supervision at all times. Any child between the ages of 8 and 12 may shoot in the Range, provided that the Primary Member or his or her spousestays in the shooting booth with the child at all times. Any child between the ages of 8 and 12 may only shoot a .22 caliber firearm, without the prior consent of the PBR General Manager. PBR reserves the right, from time to time, to limit the use of the Range by children under the age of 21 during peak periods of Range use.
- PAYMENT OF DUES; OTHER CHARGES. Monthly dues shall be due and payable on the first day of each month. The initial monthly dues shall be as set forth on the Application. The monthly membership dues may be increased at any time upon 30 days prior written notice to you by PBR. PBR may also change any other charges applicable to services provided to Members at any time. Monthly dues are required to be paid by a monthly charge to your credit card or ACH debit on your bank account. Payment terms will be set forth in the Payment Authorization executed by you and delivered to PBR with the Application. You may change the terms of the Payment Authorization by submitting a new Payment Authorization to PBR at least 30 days in advance of the next payment due date. It is the Member’s responsibility to make sure a valid Payment Authorization is on file at all times, and that a new Payment Authorization is submitted any time the applicable bank account or credit card account information is changed. You may, at your option, pay Membership dues for any 12 month period in advance and receive a discount established from time to time by PBR.
- LATE CHARGES. It is your responsibility to ensure that the method of payment set forth in the most recent Payment Authorization provided to PBR remains a valid method of payment.