You
may print this document and bring it to our meeting for your membership
application. We do not accept online applications. Please note that your
internet browser will typically print your "active window" which is the last
one in which you clicked (and in this case, that may well be the contents bar
on the left.) Click somewhere in this window (with the application), and
then click the print button in your browser. Alternately, right-click on
this application and select "Print" from the pop-up menu.
Please note that either you or your sponsor must appear at our meeting in person in order to submit this application. You may not simply mail it in with your payment.
RED
BRUSH RIFLE RANGE INC.
P.O. Box 422, Newburgh, Indiana 47629-0422
MEMBERSHIP APPLICATION -
FOR A SAFE PLACE TO SHOOT
INSTRUCTIONS
Applicants
must attend a meeting of the members to submit an application,
be
introduced to the members, and be voted on.
Applicants who cannot attend a
meeting
may be represented by their club sponsor. If
neither the applicant nor
the
sponsor is present at the meeting, the Directors may consider if the
absence
is justified and act accordingly. The
Directors are under no obligation
to
act upon any application in which all the requested information has not been
given,
or if any other requirement has not been met.
Membership meetings are
held
at the Alcoa clubhouse on the first Thursday of every month at 7:30pm.
If
you cannot attend the required meeting, state the reason. __________________
________________________________________________________________________________
Name:
(Print) _________________________________________________________________
Address:
__________________________________________ City: __________________
State:
___________ Zip Code:
_____________ Phone:
( )
_________________
E
Mail address: __________________________________
Birth
Date: ___________________
Age: ______
Citizenship: ________________
Place
of Birth: ____________________________
Special
skills: ________________________________________________________________
Place
of Employment: ____________________________
Occupation: ______________
NRA
# _______________
Expires: ___________
Club Sponsor _________________
Handgun Permit No. ____________________________ Expires: ____________________
Reason
for joining: ___________________________________________________________
Area
of shooting interest: ____________________________________________________
Are
you a past member? _______
Why did you leave before ? __________________
CRIMINAL
CONVICTIONS
Note! Having been convicted
of a crime will not
necessarily bar you from
membership. Lying will.
Have you ever been convicted of a felony? ______ Misdemeanor? ______
If
yes to either of the above, please explain below.
_______________________________________________________________________________
Are
you currently prohibited by law from owning, possessing,
or purchasing a firearm?
YES _____ NO _____
Have
you ever been judged in a court of law as being
mentally incompetent?
YES _____ NO _____
Are
you addicted to or a user of illegal drugs or
controlled substances?
YES _____ NO _____
Are
you afflicted with a disease or condition which limits
your ability to comprehend or
understand reason or
logic, or a loss of memory, that
may limit your
ability to safely use firearms
on our range?
YES _____ NO _____
WORKDAY
REQUIREMENT
Excepting
those truly disabled and members 60 years or older, all are required
to
perform a workday each year. If
you are disabled and unable to perform a
workday
for the Club, state the disability:
_______________________________________________________________________________
I
hereby certify that the answers to all questions on this application are true
and
correct. I understand that any
person who answers any of the questions
falsely
or incorrectly may be denied membership or expelled from the Red Brush
Rifle
Range, Inc. without recourse.
Also,
I am advised and understand that the Red Brush Rifle Range, Inc. may deny
membership
to any person whom the Directors believe, that in doing so, will be
in
the best interest of the corporation; that the Directors have established a
maximum
number of members allowed in the Club at any point in time; that
Regular
Members must be citizens of the United States of America or a legal
resident and eighteen (18) years of age or older.
Signature: _________________________________
CORPORATE
PLEDGE
I
certify that I am a citizen or legal resident of the United States of America
of
good repute; that I am eighteen (18) years of age or older;
that I am not a
member
of any organization or group having as its purpose or one of its
purposes
to overthrow, by force and violence, the Constitutional Government of
the
United States or any of its political subdivisions; that I have truthfully
disclosed
on my application any and all convictions for crimes, both felony and
misdemeanor;
that I am not a fugitive from justice; and that if admitted to
membership,
I will abide by the rules of the Club and will fulfill the
obligations
of good sportsmanship and good citizenship.
Signature:
_________________________________
*******************************************************************************
MEMBERSHIP
DUES
All Dues, Fees and Fines are subject to change.
Annual
Dues: $60.00 For those joining December through September
Prorated
dues: $25.00 For those
joining October & November
Reduced
Dues: $40.00 For those age 60 & over ($15.00 for Oct. &
Nov.)
Life
Member: $750.00 Read
the By-laws for all applicable conditions.
New
Member Initiation Fee: $25.00 (Due
once upon joining or re-joining)
NRA
Membership: $35.00
Annually You
must maintain membership in the NRA.
Any
past debt owed to the Club must be paid. Example:
A workday fine from a
previous
year could be due and would require payment upon renewal.
The
current
Workday fine is $30.00.
*******************************************************************************
CLUB
USE ONLY: Received by: _____________
Submitted: ____/ ____/ ____
Voted
Upon: ____/ ____/ ____
Dues
paid: ________
Init.
fee paid: ________
Applicant Accepted
YES _____
NO _____
NRA
dues paid: ________
Sent Membership card
YES _____
NO _____
Past
debt paid: ________ Issued
Priv. & Obligations YES _____
NO _____
Other:
________ Issued Range Rules
YES _____
NO _____
Issued By-laws
YES _____
NO _____
TOTAL
PAID: ________ Chartered NRA Club No. B-2645