Bury St Edmunds Pistol Club
Membership Application Form
Declaration
I declare that I am not banned from using Firearms under Section 21 of the firearms Act 1968.
Declaration section 21: It is a criminal offence for someone who is prohibited under section 21 of the 1968 firearms (amendment) act to have a firearm in his/her possession at any time. Section 21 applies to anyone who has been sentenced to imprisonment or detention in a young offender institution for three months or more. The period for which they are prohibited is five years for sentences of three months to three years, and life prohibition if the sentence is over three years.
Signed ……………………………………………………….. Date………………………..
Personal Details
Full Name……………………………………………..
Address……………………………………………………………………………………………..
…………………………………………………………..Post Code…………………………….....
Date of Birth…………………………………………….Telephone………………………………
E-mail………………………………………………………
How long at this Address?................. Years.
If less than one year, please give previous
Address………………………………………………………………………………………………....
………………………………………………………….Post Code…………………………………....
Name of employer…………………………………………………………………………………….
………………………………………………………………………………………………………….......
…………………………………………………………Post Code……………………………………...
Years’ Service………………………………………….Occupation………………………………
Note: No Contact will be made by the Club to an Employer (Reference Only)
Have you previously applied to join a rifle or pistol club? Yes/No
Please give Club Name and contact address………………………………………………………….
…………………………………………………………………………………………………………..................
Period of membership……………… Reason for leaving…………………………………………….
Do you hold a) a shotgun Certificate? Yes/No: b) a firearm Certificate? Yes/No
If yes give Number(s)…………………………………………………………………………………………
Issued by:……………………………………Constabulary
Have you ever been refused a shotgun or firearm certificate/ Yes/No
If yes please state reasons:…………………………………………………………………………….........
Is there any medical reasons why you might be refused a Firearm Certificate?
Please state (in confidence)…………………………………………………………………………….........
Sponsoring Member of Bury st Edmunds Pistol Club ………………………………………………..
Please supply 4 passport sized current photos with your application ensuring that one is signed and printed on the reverse
A copy of the club Constitution is available for inspection in the Clubhouse
……………………………FOR OFFICIAL USE ONLY…………………………………………
Date ………………….
Membership approved/declined Membership Number…………………………………………..
Chairman ……………………………………… Secretary…………………………………………..