INVERNESS CLACHNACUDDIN SMALL BORE RIFLE CLUB
Application for Club Membership
FAX to 01463 716257
Name:
DOB:          /         /
Address:
 Place of Birth:      



Post Code:
Email address:
 Land line tel no:                                        

Are you now or have you ever been a member of a rifle club : Yes/No
If yes, give Name and Address of Club:


Period of membership:
Reason for leaving:


Do you hold a Firearm or Shotgun certificate?              
Yes/No
Number and issuing Authority                                        


Details of weapons held on certificate(s)
Have you ever been refused a Firearm or Shotgun certificate, or held one and had it revoked?
If yes, give reason(s)

 Yes/No
I am not prohibited from possessing a Firearm or Shotgun by virtue of section 21 of the Firearms act 1968.  Section 21 provides that any person sentenced to imprisonment, youth custody or detention in a young offenders institution for three months or more but less than three years, is banned from holding a firearm or ammunition for five years and any person sentenced to more than a three years is banned for life from holding a firearm or ammunition.
Give names, addresses and telephone numbers of two referees who may be contacted by the Club:
First Referee:
Second Referee:
I certify that the above information is correct to the best of my knowledge and, if my application is accepted, I agree to abide by the rules and regulations of the Club at all times.  I acknowledge that data will be held electronically for the purposes of administration.  Results of competitions may be (e.g.) retained indefinitely, published on the club website, distributed to interested parties.


  Date:           /       /                             Applicants Signature ______________________________________________________


If under 18, signature of Parent or Guardian ___________________________
NOTE: Any member can have his/her membership terminated at any time for misuse of the Club, its furnishing and equipment; for shooting at other than official targets; for firing guns with caliber greater than .22; for shooting in other than shot mode and for removing equipment or ammunition from the Club without authorisation.  The Club Committee reserves the right to refuse membership and is under no obligation to give reasons, nor do applicants have the right appeal.


Police Firearms Licencing notified: via 6848
      
Transfered to database