Canberra Rifle Club New Member Registration

Basic Information

Gender*

Title*

First Name*

Second Name

Surname*

Address

Residental Address*

Residental Suburb*

Residental State*

Residental Code*

If different from Residental Address

Postal Address

Postal Suburb

Postal State

Postal Code

Contact Information

Home Phone

Business Phone

Mobile Number*

Dob*

Email*

Emergency Contact Information

Spouse Name

NOK Relationship

NOK Contact

NOK Phone

Other Information

Occupation

Place Of Birth

Licence Number

NRAA SID

Licence expiry date*

Licence State

Left Handed

Discipline

Grade

Sponsor

Country*

Comments

Declarations

Will CRC be your principal reason for obtaining a firearms licence

Is there any reason under the Firearms Act that would limit you obtaining a FL

I declare that I will abide by the Club Rules and Range Standing Orders

I declare that the information provided is true and accurate

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