CHC New Membership Application

Please print clearly or enter data in form

Contact Information Name Civic Address Apt. # or PO Box City, Prov., Postal Code Home Phone Cell Phone E-Mail Address

Required Information Are you currently a member of another club? No Yes Name of Club:

Have you taken a CSSA or club-sponsored handgun safety course? No Yes Name of Club: Date of completion:

Have you taken a Black Badge handgun course? No Yes Location of course: Date of completion:

Are you currently a member of any “shooting sports” organizations? No Yes Name of Organization:

Are interested in shooting handgun, or rifle at the Club?

Your PAL or POL # (provide a photocopy, both sides) PAL or POL Expiry Date:

What trade, skill, experience or ability do you have that you are willing to use to assist the club on occasion?

How did you hear about our club?

Date of Birth:

References Please provide the following:  A current Police Background Check (required).  (optional) A reference from another gun club, or a reference from a current CHC member. Reference Name & Club:

Applicants signature: Date:

Privacy Statement Page 1 of 2 Rev Sept-2015 By applying to become a member of the CHC your personal information will be kept confidential.

New Membership Information and Fees  Probationary (New) memberships are $125 each plus $50 training and initiation fee.

 New family memberships are $175, plus $50 training and initiation fee for each family member requiring training. Note that children or grandchildren with their own POL or PAL are not included in family memberships. There is no charge for training children or grandchildren under 18 without a POL or PAL. Separate “Junior” memberships for children under 18 may be purchased for $20

 New members are required to take the club’s handgun and range safety training.

 Membership includes $3M liability insurance with the National Firearms Association.

Enclosed is a cheque in the amount of $

OR Please send an invoice for $ to my e-mail for payment by credit card

Check List  Have you answered all of the questions on the application form?  Have you signed and dated the application form?  Have you enclosed a photocopy or scan of your PAL or POL –> BOTH SIDES?  Have you enclosed your Police Background Check report?  Have you enclosed your cheque payable to the Cornwall Handgun Club, or requested an invoice for credit card payment?

Glossary of Terms “Black Badge” An official Black Badge Holster Qualification course “PAL” Possession & Acquisition License (Restricted = Class for Handguns) “POL” Possession only license

Postal mail this application to: Cornwall Handgun Club P.O. Box 1813 Cornwall, Ontario K6H 6N6 OR E-mail: [email protected]

Allow approximately two weeks for acknowledgement of your application. All applications are subject to acceptance by the Club.

Visit our website at cornwallhandgunclub.ca

of 2 Rev Sept-2015