EMRR Club Student Membership Application Form

Student Membership Application:

If you are joining Nottingham Trent University or University of Nottingham please use the dedicated forms www.eastmidlandsregionalrange.org.uk/join-the-club/
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Home Address - Where you are from

Street Address

Street Address Line 2

CityCounty

Post Code
Uni/College Accomodation Address - Where you live in Nottingham

Street Address

Street Address Line 2

CityCounty

Post Code
Mobile Number
Personal E-mail
example@example.com
Uni/College E-mail
example@example.com
Student Number
Uni / College
Course
Year of Course

1234MastersPHD
Emergency Contact

Name

Address

CityPost Code

Contact Number
Do you have a disability or do you need assistance?
Target Shooting is fully inclusive and we have access to accommodate wheelchairs.
Do you have any previous experience or currently own any Firearms?
Please give details
Do you have a FAC / SGC (if yes please give details)
Please give details
Are you / Have you been a member of another club or shooting organisation?
Please give details
I have never had my membership of another shooting club terminated or been asked to leave

Tick to confirm statement
I have not been convicted of any offense (excluding motoring) during the last ten years?

Tick to confirm statement
I have not been refused or had revoked a FAC or SGC

Tick to confirm statement
I am not prohibited under Section 21 of the Firearms Act 1968, or otherwise, from holding or possessing any firearm or ammunition*

Tick to confirm statement
I understand that the police will be contacted for a background check*

Tick to confirm
I Agree to EMRR GDPR policy (available on request)*

Tick to confirm
REFERENCE

It a mandatory legal requirement for Home Office Approved Shooting Clubs to obtain a reference for all new members.

Please provide details of someone who can give a reference, - this should be someone who has known you for more than 2 years and you are not related to or living with.

To assist in the administration of your application, YOU MUST FORWARD THE LINK TO YOUR REFFRENCE and ask them to complete the form,

https://form.jotform.com/212773860826059
Reference Contact Details

Name

Address

CityPost Code

Email
Please provide a passport style photo - Take Photo
Signature

Clear
Please verify that you are human*
Should be Empty:

Student Membership Application: