Grove Small Arms Membership Application

Application for membership
Full Legal Name, including middle name/s:

TitleFirst NameMiddle Name/sLast Name
Any previous legal names by which you have been known:

PrefixFirst NameMiddle Name/sLast Name
Birth Date

DateMonthYear
Town and country of birth
Current Address

Street Address

Street Address Line 2

CityCounty

Post Code
Place of Birth
Phone Number (preferred). If no area code type "n/a," if there is an extension type it in.

Area CodePhone Number
Phone Number (alternate). If there is an extension type it in.

Area CodePhone Number
Email
example@example.com
Trade, Occupation, Profession:
Attach a passport-compliant photograph (in jpg format) with the file name “Surname, Initial and DOB (as DDMMYY)”, e.g. "Other A N 251299"

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Do you belong to a rifle / pistol / gun club?

If YES, please complete the following:

Rows	Specify:
Club name:
Date joined:
Club Secretary name:
Club Secretary contact e-mail address
Club Secretary contact tel. no.:
Type of membership (Full/Probationary)
Membership no:
Is this club your primary club, for the purposed of your FAC? (YES/NO)
How many times have you shot on ranges with this club in the past 12 months?
Other Rifle Clubs or Shooting Associations that you belong to + membership category description:

Over the past 12 months, on approximately how many occasions have you shot rifles at the following distances:

Rows	Specify:
25-100 m/y
100-600 m/y
> 600 m/y

Extra space if you have more to say about your current club(s)
Do you hold a FireArms Certificate?

IF YES

Rows	Specify:
Expiry date DD/MM/YYYY:
Issuing Force:
FAC Number

Do you hold a ShotGun Certificate?

IF YES

Rows	Specify:
Expiry date DD/MM/YYYY:
Issuing Force:
SGC Number

Are you now or have you ever been a member of the NRA:?
IF YES

Rows Specify:

NRA Membership no.
Do you hold a Shooter Certification Card that has been issued by the NRA either: (1) via an NRA-affiliated Club of which you are a member, or (2) directly to you as a member of the NRA?

IF YES (1 of 3)

Rows	Specify:
Expiry date DD/MM/YYYY:
State either "NRA" or the NRA Affiliated Club Name
State your "NRA Number" or NRA Affiliated Club Number

IF YES (2 of 3) Attach a photograph or PDF of your Shooter Certification Card with the file name “Surname Initial SCC Front”, e.g. "Other A N SCC Front"

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IF YES (3 of 3) Attach a photograph or PDF of your Shooter Certification Card with the file name “Surname Initial SCC Back”, e.g. "Other A N SCC Back"

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Have you had formal firearms training?
If yes, please give brief details of training or course(s) attended.
Applicants without civilian range experience will be required to attend a membership assessment and possibly attend a probationers’ course.
Attach copies of relevant training certificates/documentation.

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Health, Welfare and Safeguarding
The Club is committed to ensuring the safety and welfare of all members and visitors.

Do you have any medical, physical, cognitive, neurological, psychological or other condition that may affect:

• your ability to safely participate in shooting activities; or
• your ability to understand and comply with range safety instructions; or
• any support, supervision or reasonable adjustments that you may require whilst attending Club activities?
If YES, please provide details that you believe are relevant to your safe participation in Club activities:
The information provided will be treated confidentially and considered only by those Club officials who need to know it for safety, safeguarding or welfare purposes.
Do you consider yourself to be an adult who may require additional support, assistance or safeguarding whilst participating in Club activities?
If YES, please provide details of any support or adjustments that would assist you:
The information provided will be treated confidentially and considered only by those Club officials who need to know it for safety, safeguarding or welfare purposes.
For current and former military or Police personnel:
Have you handled firearms in the course of your duty in the police or the armed services?
IF YES When did this activity and/or training cease?:
For current and former military or Police personnel: Can you provide a statement from your existing or former senior/commanding officer saying that you have been fully trained in handling the type of firearms in respect of which the Club has obtained approval and is able to use them safely without supervision?
Firearm ownership

Details of firearms currently held and intending to be used, whilst in Grove Small Arms Club ranges:

Please list firearms possessed or variations applied for (calibre and action/type of firearms) that you would like to use on the Club’s ranges:

Rows	Action/Type	Calibre	Action/Type	Calibre
#
#
#
#
#

Disciplines

Details of past/current shooting experience and of intended shooting disciplines, with the Grove or other clubs:

Rows	Current shooting activity/ies	Intended discipline/s @ Grove
Muzzle Loading Rifle / Pistol: Firearms that are loaded with components without a cartridge case
Classic Rifle Historic firearms such as the Lee Enfield No. 4
F Class a 'free' formula usually with Scope and bipod and a ½ minute of angle bull
Target (a.k.a. Practical) Shotgun: Multi-shot semi-automatic or manual target shotgun discipline
Mini Rifle: Dynamic shooting with .22LR self-loading rifle

Add any other current or intended shooting disciplines, with the Grove or other clubs:
Declarations:

This section must be fully completed, there is a text field at the end for any extra information you might like to share. Please note that disclosure of any information does not automatically exclude you from membership. However, failure to disclose such information may result in refusal or termination of membership.
FAC Holders only:
Add any other information here
Sponsors and Referees

PLEASE NOTE: Members of the applicant’s immediate family, registered firearms dealers, serving police officers and police employees may not act as referees.
Referee 1 - Club sponsor or other Referee (must know you as a shooter and be able to state that you are a fit and suitable person to belong to a gun club). Please advise the Referee that we may make contact to discuss your application

PrefixFirst NameMiddle NameLast Name
Grove sponsor's membership number:
If your referee is a member of Grove Small Arms Club
How long have you known the Club Sponsor / Referee (minimum of 2 years) and in what capacity?
Club Sponsor / Referee Address

Street Address

Street Address Line 2

CityCounty

Post Code
Phone Number: If no area code type "n/a," if there is an extension type it in.

Area CodePhone Number
Email
example@example.com
Referee No. 2 (must know you within a social environment and be in a position of responsibility). Please advise this Referee that we may make contact to discuss your application

PrefixFirst NameMiddle NameLast Name
How long have you known Referee 2 (minimum of 5 years) and in what capacity?
Occupation:
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Phone Number: If no area code type "n/a," if there is an extension type it in.

Area CodePhone Number
Email
example@example.com
Applicant's Signature
Date

DayMonthYear
Date
If under 18, parent/guardian name
If under 18, parent/guardian signature
Should be Empty:

Application for membership

Health, Welfare and Safeguarding

For current and former military or Police personnel:

Firearm ownership

Disciplines

Declarations:

Sponsors and Referees