Name: Target and Metal Silhouette Shooting Competition
Start: 2023-02-23T18:45:00+10:00
End: 2023-02-23T21:00:00+10:00
Location: Pine Rivers Shooting Club

Membership Form 2022 - 2023

Are you paying via Credit Card, Bank Transfer, Cash or Cheque

Credit Card

Bank Transfer

Cash

Cheque

New Membership

Membership Renewal

Personal Details:

Phone

Membership Number

Email

Date of Birth

Please upload your 2 references

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Please upload your Participation Statement

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You can find a participation statement here

Please upload your Range Participation Card

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Do you have a household family member that has a current membership?

Yes

No

Membership Number

Do you have a pensioner card?

Yes

No

Please upload your Pension Card

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Do you consent to having photos taken and used by the club?

Yes

No

Do you have a current first aid certificate?

Yes

No

Expiry

Emergency Contact:

Phone

Background Information:

Do you hold a SSAA Range Pass Card?

Yes

No

Upload SSAA Range Pass Card

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Are you a member of another pistol club?

Yes

No

Which Club/s?

Do you hold a current firearms Licence?

Yes

No

Please upload your Statement of Eligibility

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What type of licence do you hold?

Category H

Category A & B

Instructor's Licence

Collector's Licence

Other Licence

Upload Category H Licence

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Upload Category A & B Licence

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Upload Instructor's Licence

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Upload Collector's Licence

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Upload Other Licence/s

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I declare I have read and agree with the declaration of acknowledgement and will adhere to the Drug and alcohol policy

Payment Information:

Please pay your membership fee at the range as soon as possible.

Adult Membership $150

Associate Membership $100

Junior Membership $80

Pensioner Membership $100

Please send your cheque through to

Pine Rivers Shooting Club Inc.

PO Box 5587,

Brendale Qld 4500

Adult Membership $150

Associate Membership $100

Junior Membership $80

Pensioner Membership $100

Credit Card and processing fees will be added in payment summary

Membership year is from 1st July to 30th June

Adult Membership $150

Associate Member $100

Junior Member $80

Pensioner Member $100

Bank Details

Suncorp

BSB 484-799

ACC 201008609

Adult Membership $150

Associate Membership $100

Junior Membership $80

Pensioner Membership $100

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Membership Form 2022 - 2023

Personal Details:

Emergency Contact:

Background Information:

Payment Information:

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