Rifle & Pistol Defense LLC
Membership Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Are you 21 years of age or older?
Yes
No
Are you a U.S Citizen
Yes
No
Cell Phone Number
What is your profession
Please list any references here that you believe will help in this application. For example, if you were in the Military/ LEO/ Contractor, etc., and describe what you did:
What type of formal firearms training have you received in the past (please include course title, date, and name of the instructor, if possible):
How long have you carried a concealed weapon.
Have you ever been convicted of a crime of violence?
Yes
No
Yes charged but not convicted
Please explain the reason why you want to receive more firearms training.
Please select what firearms you currently own
Pistol(s)
AR Rifle
Blot gun
9mm PPC
Competition pistol rig
Machine Gun
Suppressors
By submitting this application. The applicant is asserting that they are willing and able to submit payment of $2,700 within 48 hours of being selected as a new member for the 2025 range year.
Yes
No
If selected are you aware that courses will require physical fitness.
Yes
No
By signing below, you can confirm that all the information entered on this form is accurate. Once your application is reviewed and accepted, you will have 48 hours to pay the $2,700 yearly membership fee. All memberships are non-refundable and non-transferable.
Signature
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