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 Life Member New Membership Membership Renewal Life Member Associate Member (2nd Family Member)Personal Details:First NameLast NamePhoneMembership NumberEmailDate of BirthAddress Line 1Address Line 2CityStatePost CodePlease upload your 2 referencesChoose File Please upload your Participation StatementChoose File You can find a participation statement herePlease upload your Range Participation CardChoose File Do you have a household family member that has a current membership? Yes NoMembership NumberDo you have a pensioner card? Yes NoPlease upload your Pension CardChoose File Do you consent to having photos taken and used by the club? Yes NoDo you have a current first aid certificate? Yes NoExpiryEmergency Contact:Emergency Contact (First Name)(Last Name)PhoneBackground Information:Do you hold a SSAA Range Pass Card? Yes NoUpload SSAA Range Pass CardChoose 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 EligibilityChoose File What type of licence do you hold? Category H Category A & B Instructor’s Licence Collector’s Licence Other LicenceUpload Category H LicenceChoose File Upload Category A & B LicenceChoose File Upload Instructor’s LicenceChoose File Upload Collector’s LicenceChoose File Upload Other Licence/sChoose 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 $110Pay with Card (Stripe)No payment items has been selected yetSubmit Form Share this:TweetLike this:Like Loading...
