Membership Application Form - Marylebone Rifle & Pistol Club
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Marylebone
Rifle & Pistol Club
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Membership Application Form
Members
MRPC Application Form
In order to join the club, please complete the following details and submit to the club.
Personal Information
Surname*
Forenames (including middle names) *
Title*
Previous Surname's or Forename's
Official Permanent Address*
Post Code*
If less than five years at current addresss, please give details of previous home addresses, must include Post Code.
Previous Address
Email Address*
Repeat Email Address*
Mobile No*
Landline
Gender*
DOB*
Nationality*
Country of Birth, including City\Town*
Employment\Company Information
Occupation or Profession*
Company Name*
Nature of Business*
Company Address
Post Code
Other Information
Do you already hold a Firearm Certificate *
Yes
No
FAC Number
Issuing Authority
Expiry Date
Are you a NRA Member*
Yes
No
NRA No
If you are, or have been, a member of any other Club, Association or Society connected with shooting or firearms, please list them with dates of joining and leaving.
Details of Previous Clubs
Refused membership of a Shooting Club*
Yes
No
Please give details
Application for a Firearm Refused or Revoked*
Yes
No
Any reason police may refuse to grant an FAC*
Yes
No
If Yes, give FULL DETAILS
Attach Key Documents
Attach Passport Size Photo*
Attach Personal Identification Documents*
Attach Proof of Residence Documents*
References
Please give the names and permanent residential addresses of 2 referees. These cannot be close family. One can be a friend of at least three years and the other should be someone more formal e.g., a work colleague, Both referees must have UK addresses. If you are currently, or have within the last 2 years been a member of a shooting club, one of the referees MUST be the Secretary of that club.
Referee One
Full Name*
Relationship*
No Of Years Known*
Address*
Post Code*
Email*
Contact Number*
Referee Two
Full Name*
Relationship*
No Of Years Known*
Address*
Post Code*
Email*
Contact Number*
Additional Informaton
Additional Information
Agreement
Agreement Conditions*
I HEREBY STATE THAT ALL THE FOREGOING INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
In providing the above information you consent to your details being sent to the Police for verification.
We will contact you once we have received confirmation from the Police.
I agree
Check word:
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