Surrey Rifle and Pistol Club

Title

First Name *

Last Name *

Any previous names

Date of Birth *

Occupation *

Telephone *

Email Address *

Password *

Password Again *

House Number/Name + Street *

Address line 2

Address line 3

Town *

County *

Postcode *

Declarations

I certify that I am not prohibited from possessing firearms or ammunition under section 21 of the Firearms Act 1968 as amended. (ie: I have not been sentenced to a term of imprisonment of 3 months or more)

Digitally Signed

I certify that I am not currently subject to an ongoing police investigation or awaiting sentencing.

Digitally Signed

Have you ever had an application for a firearms certificate or a shotgun certificate refused by the Police or have you had a certificate revoked.

Yes

Digitally Signed

I confirm that I am happy with Surrey Rifle and Pistol Club to hold my data under current regulations in the Data Protection Act 2018. All data will be sent over SSL and will be encrypted with the latest technologies before saving.

Digitally Signed