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APPLICATION FORM FOR MEMBERSHIP PERSATUAN MENEMBAK SELANGOR

( SELANGOR SHOOTING ASSOCIATION )
NATIONAL SHOOTING RANGE SUBANG, P.O. BOX 12464, 50778 KUALA LUMPUR TEL : 03 – 7846 1606, 7846 2472 FAX : 03 – 7846 2462 Email : selangor.shooting.association@gmail.com / shooting@tm.net.my Website : www.gunclub.org.my

PRINCIPLE TWO ( 2 ) PASSPORT SIZE PHOTOGRAPHS TO BE ATTACHED

SPOUSE TWO ( 2 ) PASSPORT SIZE PHOTOGRAPHS TO BE ATTACHED

FULL NAME OF APPLICANT & TITLE ( If any ) NATIONALITY N.R.I.C. NO. SPOUSE NAME & TITLE ( If any ) N.R.I.C. NO / DATE OF BIRTH HOUSE ADDRESS ( Please state ( √ ) correspondence address )
House Office

SEX DATE OF BIRTH

DATE OF BIRTH

TEL : NAME OF COMPANY & ADDRESS

H/P :

TEL : OCCUPATION FIREARMS IN POSSESSION ( Please enclose a photocopy of your License ) GUN TYPE

FAX :

MAKE

CALIBRE

License No : _____________________________ CLASS OF MEMBERSHIP (LIFE/ASSOCIATE/ORDINARY/JUNIOR/GROUP)

I HEREBY APPLY FOR MEMBERSHIP OF THE ASSOCIATION. I AGREE TO BE BUND BY THE RULES AND REGULATIONS OF THE ASSOCIATION

SIGNATURE : ………………………………………………………………… DATE : ………………………………………………………………… FOR OFFICIAL USE Membership No Application received on Application approved on

DECLARATION BY PROPOSER* & SECONDER* We, the proposer and seconder of the above applicant declare that he/she is personally known to us and is a fit and proper person to become a member of the Association

………………………………
Signature of Proposer

………………………………
Signature of Seconder

………………………………
(Name & Membership No.)

……………………………….
(Name & Membership No.)

Date : …………………………………….... ( President )

N.B.

Before an application can be processed, the Application Form & the Vetting Procedure Form for using the firearms in the Selangor Shooting Association compound must be properly completed and signed. Two (2) passport size photographs and photocopy I/C each must be submitted (Principle & Spouse). The Entrance Fee and the Annual Subscription must be paid upon submission of the above Forms. All membership is NOT TRANSFERABLE & REFUNDABLE. Membership will be refunded if the application is not approved by the Committee or the Police. MEMBERSHIP FEES TERM OF PAYMENT

Entrance Fee
i. ii. iii. iv. v. Life Member Ordinary Member Associate Member Junior (Under 21 years old) Group Membership RM10,000.00 RM 2,000.00 RM 1,000.00 RM 100.00 RM500.00 RM500.00 RM 60.00

Annual Subscription
Nil RM250.00 (Age above 60) RM250.00 (Age above 60) CASH / CHEQUES ONLY. All cheques must be in favour of “SELANGOR SHOOTING ASSOCIATION” and crossed “A/C PAYEE ONLY”.

RM 5,000.00

RM100.00 per member