WAGGA WAGGA CITY PISTOL CLUB INC PO BOX 5185 WAGGA WAGGA NSW 2650

Junior 12-18 Years

This application and the current annual fee are to be returned to the Secretary. I (full name) ______________________________________________________________________________ herby apply for membership of the Wagga Wagga City Pistol Club Inc with the consent of my parent or guardian as listed below. Residential Address:

Postal Address:

Date of Birth: Email Address: Have you ever been a member of a Pistol Club?

YES / NO

If YES Which Club and When: ______________________________________________________________ Minor’s Target Pistol Number: __________________________

Expiry Date: ____________________

Minor's Firearm Permit Number (longarms):_________________ Expiry Date: ____________________ Endorsed Firearm Categories: A   B  H Please note category A and B can only be fired at the club with a target genuine reason.

Name and Address of Parent / Guardian

Parent/Guardian’s Driver’s Licence Number: Parent/Guardian Home Phone

Expiry Date:

Parent/Guardian Mobile Phone

Parent/Guardian Work Phone

Is there any reason for the Commissioner of Police to refuse your application for membership?

YES / NO

I herby certify that the above details are correct to the best of my knowledge and agree to abide by the Constitution and By Laws of the Wagga Wagga City Pistol Club Inc. and obey the Standard Rules for Safety and Conduct on a Pistol Range at all times. Signature of Applicant: _____________________________________

Date: __________________

Signature of Parent or Guardian: ______________________________

Date: __________________

Club Use: Annual Fees: _____________ PPL Expiry Date: _________________

Date Joined: _____________

NSWAPA Notified: ____________

Safety Training Completion Date: __________________