Membership Form Club Membership Form (#7)ΔMembership Form 2023 - 2024Are you paying via Credit Card, Bank Transfer, Cash or Cheque Credit Card Bank Transfer Cash Cheque New Membership Membership RenewalPersonal Details:First Name Last Name Phone Membership Number Email Date of Birth Address Line 1 Address Line 2 City State Post Code Please upload your 2 references Choose File Please upload your Participation Statement Choose File You can find a participation statement herePlease upload your Range Participation Card Choose File Do you have a household family member that has a current membership? Yes NoMembership Number Do you have a pensioner card? Yes NoPlease upload your Pension Card Choose File Do you consent to having photos taken and used by the club? Yes NoDo you have a current first aid certificate? Yes NoExpiry Emergency Contact:Emergency Contact (First Name) (Last Name) Phone Background Information:Do you hold a SSAA Range Pass Card? Yes NoUpload SSAA Range Pass Card Choose File Are you a member of another pistol club? Yes NoWhich Club/s? Do you hold a current firearms Licence? Yes NoPlease upload your Statement of Eligibility Choose File What type of licence do you hold? Category H Category A & B Instructor's Licence Collector's Licence Other LicenceUpload Category H Licence Choose File Upload Category A & B Licence Choose File Upload Instructor's Licence Choose File Upload Collector's Licence Choose File Upload Other Licence/s Choose File I declare I have read and agree with the declaration of acknowledgement and will adhere to the Drug and alcohol policyPayment Information:Please pay your membership fee at the range as soon as possible. Adult Membership $175 Associate Membership $100 Junior Membership $80 Pensioner Membership $110Please send your cheque through to Pine Rivers Shooting Club Inc. PO Box 5587, Brendale Qld 4500 Adult Membership $175 Associate Membership $100 Junior Membership $80 Pensioner Membership $110 Credit Card and processing fees will be added in payment summaryMembership year is from 1st July to 30th June Adult Membership $175 Associate Member $100 Junior Member $80 Pensioner Member $110Bank Details Suncorp BSB 484-799 ACC 201008609 Adult Membership $175 Associate Membership $100 Junior Membership $80 Pensioner Membership $110No activated payment method found. If you are an admin please check the payment settingsNo payment items has been selected yet Submit Form Share this:TweetLike this:Like Loading...
