Membership sign up PDF form

SHOOT STRAIGHT RANGE MEMBERSHIP

Please complete and submit application
Name*

First NameMiddle NameLast Name
Address*

ADDRESS

Street Address Line 2

CitySTATE

ZIP
MaleFemale
Phone Number*
Please enter a valid phone number.
EMAIL*
example@example.com
Date of Birth*

MonthDayYear
Date
Drivers License Number*
STATE*
ALIEN REG #
If non U.S. citizen
RELEASE OF LIABILITY
It is expressly agreed that all use of equipment or facilities of Shoot Straight are undertaken at the sole risk of the undersigned. Undersigned hereby agrees to hold harmless, release and forever discharge Shoot Straight, its operators, agents, servants, employees, consultants, advisors, owners, and lessors of its equipment from any and all claims for injury, death or damage to the undersigned's person or property arising out of or in connection with the use of the premises or equipment and from all acts of active or passive negligence on the part of Shoot Straight. I agree to abide by all rules and regulations of the gun range as determined by the management while | am using the facilities of Shoot Straight. I acknowledge receipt of and have read the Range Rules of Shoot Straight.
SIGNATURE*

Clear
DATE

MonthDayYear
Date
Family Memberships
If application is for a Family Membership, please list the other members included in your membership and their relationship to you. Family members may include a spouse, and up to four children under 21 years of age living at the same address.
Spouse

Full NameAge
Child 1

Full NameAge
Child 2

Full NameAge
Child 3

Full NameAge
Child 4

Full NameAge
NON-RECURRING BILLING MEMBERSHIPS
Select One if applying for non-recurring membership

SINGLE 30 DAYS ($40)SINGLE 12 MONTHS ($300)FAMILY 12 MONTHS ($360)LEO SINGLE 12 MONTHS ($225) ID requiredLEO FAMILY 12 MONTHS ($275) ID requiredNONE
SIGNATURE

Clear
DATE

MonthDayYear
Date
RECURRING BILLING MEMBERSHIPS
Select one if applying for a recurring membership

SINGLE MONTHLY ($25)SINGLE YEARLY ($300)FAMILY MONTHLY ($30)FAMILY YEARLY ($360)NONE
I hereby authorize regularly scheduled charges to my credit card in the amount and billing frequency selected below. I agree that no prior notification will be provided prior to each scheduled payment. The charge will appear on your credit card statement.

I understand that this authorization will remain in effect until I request to cancel in writing, and I agree to notify Shoot Straight Inc. in writing of any changes to my account information, or termination of this authorization at least 15 days prior to the next billing date. All recurring billing prices are subject to change. | understand that any changes or cancellations to my account will not result in reimbursement or proration of previous charges. | certify that I am an authorized user of the credit card provided and will not dispute the scheduled transactions with my credit card company, provided the transactions correspond to the terms indicated in this authorization form.
SIGNATURE*

Clear
Date

MonthDayYear
Date
Should be Empty:

SHOOT STRAIGHT RANGE MEMBERSHIP

RELEASE OF LIABILITY

Family Memberships

NON-RECURRING BILLING MEMBERSHIPS

RECURRING BILLING MEMBERSHIPS