GREAT FARM RIFLE CLUB
Please print clearly and answer all questions. Incomplete or illegible applications will be returned.
First MI Last
Street City State Zip
Home Phone: ( ) Work Phone: ( )
NRA Member Number (See discount below) ___________ Expiration Date __
PD affiliation (if any):_________________________
Person who referred you to the club (if anyone):____________________________
I certify that I am not a member of any group or organization that advocates the overthrow of the government of the United States of America and that I have never been convicted of a felony or a disqualifying conviction for domestic assault. I further certify that if admitted to membership I will faithfully endeavor to fulfill the obligations of good sportsmanship and citizenship and I agree to fully abide by the rules, regulations and by-laws of the Great Farm Rifle Club. I fully understand that an untruthful statement to the above is just cause for revoking my membership.
Applications will be reviewed and voted on by club officers. Subsequent pending applicants will be required to attend a range safety assessment and orientation given by the appointed officers of the range. Pending applicants will be notified of an appointment time to meet with range officers.
My submission of this form implies that I have read and understand this form and the attached range rules and will abide by the rules of the range should my membership be approved.
Signature: Date: __
Mail to: Great Farm Rifle Club
PO BOX 345
Brooks, ME 04921