Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

Date of Birth

MM

DD

YYYY

Do you have a pistol permit? *

Yes (We need to see it)

No (Need to get a NICS Check)

No, but I have an application pending

Have you taken a basic pistol course? *

Yes

No

Were you ever denied a pistol permit? *

Yes

No

Do you belong to: *

NRA

NYSRPA

SCOPE

None of the above

Are you interested in shooting indoor and/or outdoor pistol leagues? *

Yes

No

Date *

Today's Date

MM

DD

YYYY

I hereby subscribe to the Constitution and By-Laws of the Clarence Shooting Club, Inc. *

I certify that I am a citizen of the United States of America and that I am not a member of any organization which, has as any part of its program, the attempt to overthrow the government of the United States or any of its political subdivisions, by force or violence, and that I have never been convicted of a crime of violence and if admitted to membership, I will faithfully endeavor to fulfill the obligation of good sportsmanship, good citizenship, and abide by the by-laws of the Clarence Shooting Club, Inc.

By checking here, you are attesting that you have read the above statement and it is true.