1066 Rifle & Pistol Club
Membership Form

Please note -To become a full memmber you must attend 6 times in 3 months then attend regularly. For Heritage section you will need to be a Full Member for 1 year, have a FAC and 1066 RPC must have a space for you.

Title *

Last Name *

Forename (please state all) *

Any other names (i.e Maiden Name)

Age Range *

Date Of Birth * +

Place of Birth *

Country of Birth *

Occupation *

Email Address *

Home Phone Number

Mobile Phone Number

Current Address

House Number or Name *

Street Line 1 *

Street Line 2

Town *

County *

Post Code *

Other Address Within Last 3 Years (1)

House Number or Name

Street Line 1

Street Line 2

Town

County

Post Code

Other Address Within Last 3 Years (2)

House Number or Name

Street Line 1

Street Line 2

Town

County

Post Code

Identification (For Safety Course)

Photo ID to be used when attending Safety Course *

Other ID - Specify Below

Photo ID Number *

Membership Class

Class of Membership *

Firearms Information

Do you hold a Firearms Certificate (FAC) ? *

Yes

No

FAC Number

Do you hold a Shotgun Certificate (SGC) ? *

Yes

No

SGC Number

Other Current Shooting Club Memberships or Shooting Qualifications

Junior Applicant (8 - 18 years old)

Name of Responsible Adult

Relationship to Junior

1066 Membership Number

New Member Questionaire and Agreement

What is the main reason for your application to 1066 Rifle and Pistol Club *

Have you had any experience on ranges before *

Do you belong to any organizations / groups that seek to discredit target shooting clubs *

Yes

No

Do you belong to any organizations / groups that are deemed to hold radical views - If Yes please list organisations / group *

Yes

No

Details of Groups / Organisations

Are you or have you been a journalist if yes to either what was your specialty *

Yes

No

Journalist Specialisation Description

Do you have any strong Religious or Political views *

Yes

No

You need to attend the club no less than 4 times per year, can you commit to this *

Yes

No

Any comments made by members that you find offensive will be investigate without prejudice by 1066 RPC Management board, these must be made in writing. These are not to be discussed outside the structure of 1066 RPC, can you commit to this. *

Yes

No

Any changes to your circumstances need to be notified to the club asap, can you commit to this. *

Yes

No

Do you have a Criminal Record *

Yes

No

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 also hereby declare that the information provided is true and correct. I also understand that any wilful dishonesty may render for refusal of this application or immediate termination of membership.

I accept the above declaration *

Yes

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

Yes

1066 Rifle & Pistol Club Membership Form

Please note -To become a full memmber you must attend 6 times in 3 months then attend regularly. For Heritage section you will need to be a Full Member for 1 year, have a FAC and 1066 RPC must have a space for you.

Current Address

Other Address Within Last 3 Years (1)

Other Address Within Last 3 Years (2)

Identification (For Safety Course)

Membership Class

Firearms Information

Junior Applicant (8 - 18 years old)

New Member Questionaire and Agreement

1066 Rifle & Pistol Club
Membership Form