1066 Rifle & Pistol Club
Membership Form

New Member Information

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Current Address

Other Address Within Last 3 Years (1)

Other Address Within Last 3 Years (2)

Identification (For Safety Course)

Membership Class

Firearms Information

Do you hold a Firearms Certificate (FAC) ? *
Do you hold a Shotgun Certificate (SGC) ? *

Junior Applicant (8 - 18 years old)

Please read and accept the following declaration Under Section 21 of The Firearms Act 1968.

It is an offence for a person who is prohibited by Section 21 of The Firearms Act 1968 to have a firearm or ammunition in his/her possession at any time. This section applies to any person who has been sentenced to imprisonment or to youth custody or detention in any young offender’s institution for three months or more.

A person sentenced to 3 years or more is prohibited for life
It is an offence for a person to transfer, let, hire or lend a firearm or ammunition to someone whom he/she knows or has reasonable grounds for believing to be prohibited person.

By agreeing this statement you are confirming the following statement: -

I hereby declare that I have never had a firearm or shotgun application refused or such a certificate revoked. I also declare that I am not a person prohibited by virtue of Section 21 of The Firearms Act 1968.

I accept the above declaration *
Please read and accept the 1066 Rifle and Pistol Club Privacy policy *
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