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1
Please enter the date you will be attending Malabar Rifle Range (not the date of completion)
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Date
Day
Month
Year
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2
Name
First Name
Last Name
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3
License No
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Firearm License No.
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4
License Type
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License
Minors Permit
P650
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5
License Expiry Date
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Date
Day
Month
Year
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6
USI SID Number
Found on Membership Card (Skip if P650)
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7
Category of Shooting Attendance
Please select all that apply today
Shooter .22
Range Officer
Coach
Licensed Parent
P 650
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8
Location Attending
Please select all that apply today, do not tick clubhouse if you are not attending the Clubhouse.
Horseshoe
Clubhouse
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9
Upload P650
Only if Applicable
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: 10.6MB
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10
Firearm License
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: 10.6MB
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11
E-mail
example@example.com
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12
Terms and Conditions
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13
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Great Product Name
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Great Product Name
$20
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Great Product Name
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ORDER SUMMARY
Total cost
USD
Range Fee - Horseshoe
$
20.00
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Credit Card Number
Security Code
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