CIVILIAN DEFENSIVE SHOOTERS ALLIANCE MEMBERSHIP APPLICATION FORM

New Member ________ Renewal ________ I.D No. _________________ PERSONAL DETAILS Name ____________________________________________________________________________________ FAMILY FIRST MIDDLE Birthdate _____________________ Birthplace _________________________ Age_________ Occupation ___________________________________ Nickname/Username _______________________ Date _________________

Residence Address _________________________________________________________________________ Telephone No.____________ Cellphone No. _______________ Email Add. ___________________________ In case of emergency please notify _________________________Cellphone No. _____________________ REQUIREMENTS 1. Attach 1 copy each of 1x1 and 2x2 colored pictures. 2. Unexpired photocopy of Firearm license, any Valid I.D., PTT, or PTCFOR ONLY. 3. Membership Fee : 6 months trial membership program: ______________ Period: __________________ Annual membership: ____________________________ Period___________________ Have you ever been a member of any gun club or shooting discipline ?< YES > / < NO > If yes, what is the name of the club or shooting discipline? __________________________________________ Please evaluate yourself as a shooter ;< Novice >< Advance ><Expert > WAIVER / CERTIFICATION I _______________________________________________, certify that the above information are true and correct and give my consent to CDSA to verify all of the above. In connection with the application for membership, it is understood that I shall not hold the Civilian Defensive Shooters Alliance and Shooting Ranges where CDSA will held training activity, liable for any criminal and or civil liability out of injury, damage, loss of life and property I may incur while inside the said shooting ranges and their supervision. TO WAIVE AND RELEASE ANY AND AND ALL CLAIMS TO CDSA AND ITS FOUNDING MEMBERS ARISING FROM NEGLIGENCE, PERSONAL INJURY, INJURY TO OTHERS AND LOSS OF LIFE AND DAMAGE TO PROPERTY. I have read this waiver and certification, and I have agreed to be bound by it. CDSA has the right to deny any person or entity to use its facilities. The same applies to the termination of membership with the gun club, for any unsafe acts or conduct unacceptable to the shooting discipline.

__________________________________ Signature Over Printed Name

_____________________________________ Endorsed by: (Signature Over Printed Name)

APPROVED BY CDSA CLUB PRESIDENT ___________________________