Romsey Shotgun Club

WITH THE EXCEPTION OF WHERE STATED, PLEASE DO NOT ALTER THIS FORM OR REMOVE ANY WORDING Romsey Shooting Club * Membership Renewal/Probationers Application ( *Please delete as applicable) 1.09.17 – 31.08.18 I HAVE NO OBJECTIONS TO THIS INFORMATION BEING HELD ON THE CLUB’S COMPUTERISED RECORDS Family Name ………………………… Date of Birth …….....… Membership Number...... Given Names...... Occupation………...... …….….….. Full Postal Address………………………………………...... Postcode… Telephone Number……………….....…. Daytime (if available)……………...………....…… Mobile Number ……….…...... …………E-mail Address………………………………...…... My Shotgun Certificate Number is ……………………….…...…... Expiry Date……...... …… My Firearms Certificate Number is ………………………....…….. Expiry Date……………… Name of FAC Designated Club………………………………………………………………... Have you ever had an Application for a Shotgun or a Firearm Certificate refused or had a Certificate revoked or partially revoked? *Delete as appropriate: - YES*/NO* If YES, please supply details overleaf Have you ever had an Application for Membership of a Shooting Club/Organization refused, revoked or partially revoked? *Delete as appropriate: - YES*/NO* If YES, please supply details overleaf I am not prohibited from possessing or using a firearm or ammunition by virtue of Section 21 of the Firearms Act 1968. (See Over) Initial……… List all other Shooting Clubs/ Organizations (and Membership Numbers) you belong to or have ever belonged to. Please underline all current Shooting Clubs/Organizations: - …………………………………………………………………………………………………......

IT IS A CONDITION OF MEMBERSHIP THAT YOU TAKE AND PASS A UKPSA BASIC SHOTGUN SAFETY COURSE AT THE EARLIEST CONVENIENT OPPORTUNITY BUT BEFORE MEMBERSHIP RENEWAL. *Delete as appropriate: - I HAVE* / HAVE NOT* passed a UKPSA Basic Shotgun training course. *Add where applicable: - Date Passed...…….…………. Venue……...…………….……..Examiner…………………… UKPSA Membership No..……………………..Competition Licence No……………..…….. *I have made a Bank Transfer / *I enclose Payment - for my: - *Probationers Admin fee of £10…….. *Standard Adult Membership Fee of .... £35*…. £41.00*…. £49.85* *Inclusive Adult Membership Fee of .... £100* .... £106.00* .... £114.85* *Delete as Appropriate: Cheques should be made payable to: - Romsey Shooting Club. I DECLARE THAT THE INFORMATION SHOWN ABOVE IS CORRECT AND I UNDERTAKE TO ABIDE BY THE RULES OF THE ROMSEY SHOOTING CLUB.

Print Name………………………………Signature………………………..Date…………….. Send your Membership Renewal Application Form and Payment to: - Debbie Lawrence, 9 Willow Close, Hedge End, Southampton, Hants, SO30 0PW If a Bank Transfer has been made, this Form may be E-mailed to: - [email protected] RSC Bank Details: - Barclays Bank. Account name: Romsey Shooting Club: Account No. 50134538: Sort Code: 20-79-25

DL-Memsec 2017/18 WITH THE EXCEPTION OF WHERE STATED, PLEASE DO NOT ALTER THIS FORM OR REMOVE ANY WORDING

Section 21 of the Firearms Act 1968

It is an offence for any person who is prohibited under Section 21 of the Firearms Act to have in their possession a firearm (includes shot gun) or ammunition (does not include shot gun).

Section 21 applies to any person who has been sentenced to a term of imprisonment, youth custody or detention in a young offender’s institution for more than three months.

With the enactment of Section 110 of the Anti-social Behaviour Crime and Policing Act 2014, this includes persons whose sentence has been wholly or partially suspended.

For a sentence of more than three months but less than three years, this prohibition remains in place for five years following the date of release.

For a sentence of more than three years, the prohibition is in place for life.

It is an offence for a person to transfer, let or hire, give or lend a firearms (includes shot gun) or ammunition (does not include shot gun) to any person whom he/she knows, or has reasonable grounds to believe, to be a Prohibited Person.

In order for a person to shoot under the exemption from the requirements for firearms licensing, either as a “Guest” at a rifle club, or as granted under Section 11 (6) of the Firearms Act 1968, completion and signature of this form will act as declaration that such individuals are not a Prohibited Person, as defined by Section 21 of that Act.

DETAILS OF REFUSAL OR REVOCATION: -

DL-Memsec 2017/18 WITH THE EXCEPTION OF WHERE STATED, PLEASE DO NOT ALTER THIS FORM OR REMOVE ANY WORDING NRA Member Non NRA Additional Fees Membership Member Standard £35 £41 £49.85 Range Fees applicable on all Membership shoots Inclusive £100 £106 £114.85 Range fees applicable for all Membership Open shoots and shoots held at (includes Manor Farm practice and Championship shoots)

ROMSEY SHOOTING CLUB MEMBERSHIP RECORD AS AT 1 SEPTEMBER 2017

Members Name:

I have no objections to this information being held on the clubs computerised records

Probationary Date: * (if known) Date of Birth: *

Membership Date: * Membership Number: *

Occupation: *

Shot Gun Certificate Number: * Valid Until: *

Firearm Certificate Number: * Valid Until: *

Name of FAC Designated Club: *

Date UKPSA PSG Safety Course Passed: *

UKPSA Membership Number: *

UKPSA Competition Licence Number: *

NRA Membership Number: *

NRA Certification Card Origin: *

Range Qualifications: *

Member of Other Shooting Organizations: * * *

CALIBRE TYPE MAKE ACTION ID NUMBER A B C

DL-Memsec 2017/18 WITH THE EXCEPTION OF WHERE STATED, PLEASE DO NOT ALTER THIS FORM OR REMOVE ANY WORDING D E F

Signed: * Date: *

DL-Memsec 2017/18