APPLICANT INFO

Name ___________________________________   Date _______________

Address ____________________   Town _______________   State _____   Zip _____

E-Mail ______________________________   Phone (     ) _______________

Employer ______________________________   Bus. Phone (     ) _______________

Address ____________________   Town _______________   State _____   Zip _____

Occupation ____________________   Years Employed __________

Date of Birth __________        ___ Married   ___ Single

Name of Spouse ____________________

Names of Children (under 21) ________________________________________

Activities I would enjoy (check all that apply):

___ Skeet     ___ Trap     ___ 5-Stand     ___ Rifle     ___ Pistol     ___ 3-D Archery

I am a member of:

___ NRA     ___ NSSA     ___ ATA     ___ Other - specify: ____________________

Please list any other Gun or Hunting Club to which you belong: ____________________

Pistol Permit:  ___ Yes     ___ No     If yes, State _____   Permit # _______________

FFL:  ___ Yes     ___ No     If yes, FFL # _______________

Are you a U.S. Citizen?  ___ Yes     ___ No

Are you a convicted felon?  ___ Yes     ___ No

Do you know and abide by the rules of safe gun handling?  ___ Yes     ___ No

Are you willing to volunteer for committees? (check all that apply)

___ Skeet     ___ Trap     ___ 5-Stand     ___ Rifle     ___ Pistol     ___ 3-D Archery

SPONSOR INFO

Name of Sponsor ____________________   Phone (     ) _______________

Signature of Sponsor _________________________   Date _______________

Number of years sponsor has known applicant __________

In handling firearms, the applicant is:

___ Inexperienced     ___ Safe     ___ Experienced     ___ Unknown

TWO ADDITIONAL REFERENCES

Name ______________________________   Phone (     ) _______________

Address ____________________________________________________________

Name ______________________________   Phone (     ) _______________

Address ____________________________________________________________

If I become a member, I agree to abide by the Constitution and Bylaws of the Hartford Gun Club, Inc. I understand that I may be liable for any injury or damage caused by me, my family, or my guests.

Applicant Signature _________________________   Date _______________

Applicant interviewed by: ______________________________

Interviewer Signature _________________________   Date _______________

Dues Amount _______  +  Assessment Amount _______  =  Total Due _______

Method of Payment:  ___ Check     ___ Money Order

CLICK HERE to view current Dues & Fee Structure.