Surname: ________________________ G1 ________________ G2 ______________________________
P.A.L. Number: ______________________________________ Expires: ___________________________
Have you attached a photocopy of your PAL ? YES NO
Issued for : Non-Restricted Restricted Prohibited Other
Address: __________________________________________________________________________
____________________________________________________________________________
Home #: __________________________ Cell #: _____________________________________
Work #: __________________________ E-Mail: _____________________________________
Employer: ___________________________________________________________________________
Position: ___________________________________________________________________________
Please list names of any GRC members that you know: _______________________________________
_______________________________________________________________________________________
Are you a member of another handgun or shooting club? YES NO
If yes what club(s) are you a member at? __________________________________________________
Do you possess a valid ATT for target shooting? YES NO
If yes, have you attached a copy of your ATT? YES NO
Have you completed the CSSA club level course? YES NO
If yes, when and where? _______________________________________________________________
May we apply to obtain your firearm training records? YES NO
(This check must be conducted by the police service in the jurisdiction where you reside).
Why are you applying to become a member of the Georgetown Revolver Club?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
By making this application you certify to the Georgetown Revolver Club, GRC, that the above information is correct. Furthermore, if you are accepted as a member you agree to abide by the rules and regulations of the GRC. Acceptance of all membership applications is subject to the approval of the general membership of the GRC at a regular monthly business meeting.
Applicant's Signature: __________________________________ Date: ___________________
