Membership Renewal Application – Office Use Membership Renewal Application-Office Use Chester Rod and Gun Club, Inc. 99 Rod and Gun Club Road Chester, NH 03036 (603) 887-4629 www.chesterrodandgunclub.com Application for Calendar Year * Application Type * New Renewal Please note: There is a one time $125.00 non-refundable Application Fee for New Applications. Membership Type * Single Family Student Senior Active Military Membership Dues: Single $150.00 | Family $150.00 | Student $65.00 | Senior $75.00 (age 65) | Active Military $0.00 Include Spouse/Partner on Membership? * Yes No No additional fee. Spouse/Partner Full Access or Escort Only * Full Access Escort Only Will the Spouse/Partner Member require a full access badge (Orientation and Safety Training required) or an escort only badge (they must be escorted by a full member but are exempt from guest fees)? Primary Member Information FirstName * LastName * Suffix Member No. * Gender * Male Female Date of Birth * Format for typing this entry is ##/##/#### or use the popup date picker calendar. Age You must be 65 or older to qualify for a Senior Membership. If you have made an error in the Date of Birth, please correct it. If not, please select a different membership type. Email Unique email addresses are required for several online Members Areas functions. If you don't have an email account, free accounts are available from gmail, yahoo, hotmail, and many other providers. We encourage you to create an email account and to notify us when you have a new email address. Phone * Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Are you a US Citizen? * Yes No Are you a lawful permanent resident of the US? * Yes No What is your alien registration number? * Have you ever been convicted of a felony? * Yes No Do you have any outstanding warrants? * Yes No Have you ever been convicted of a domestic violence offense? * Yes No Have you ever had a membership refused or revoked at any gun club? * Yes No Are you presently under the restrictions of a restraining order * Yes No Are you now under any kind of indictment in any jurisdiction? * Yes No Are you a member of the NRA? * Yes No What is your NRA Membership Number? Are you a life member of the NRA? Yes No Spouse/Partner Member Information S/P FirstName * S/P LastName * S/P Suffix S/P Member No. * S/P Gender * Male Female S/P Date of Birth * Format for typing this entry is ##/##/#### or use the popup date picker calendar. S/P Age One of the persons on this Application must be 65 or older to qualify for a Senior Membership. If you have made an error in either Date of Birth, please correct it. If not, please select a different membership type. The sharing of an email address is not supported. Several of our online Members Area functions require a unique email address. If you don't have your own email address, please leave this field blank. S/P Email If you don't have your own, unique email address, please leave this field blank for now. Unique email addresses are required for several online Members Areas functions. If you don't have an email account, free accounts are available from gmail, yahoo, hotmail, and many other providers. We encourage you to create an email account and to notify us when you have a new email address. S/P Phone S/P Are you a US Citizen? * Yes No S/P Are you a lawful permanent resident of the US? * Yes No S/P What is your alien registration number? * S/P Have you ever been convicted of a felony? * Yes No S/P Do you have any outstanding warrants? * Yes No S/P Have you ever been convicted of a domestic violence offense? * Yes No S/P Have you ever had a membership refused or revoked at any gun club? * Yes No S/P Are you presently under the restrictions of a restraining order * Yes No S/P Are you now under any kind of indictment in any jurisdiction? * Yes No S/P Are you a member of the NRA? * Yes No S/P What is your NRA Membership Number? S/P Are you a life member of the NRA? Yes No Conditions of Membership I UNDERSTAND that I am not eligible to be presented for membership acceptance until I have attended the required orientation meeting, and firearms safety class, and have passed the range rules test. (new members only) I WILL be present at the meeting of my membership acceptance and provide photo I.D. (new members only) I UNDERSTAND that I must present documentary evidence of my lawful ability to own firearms, per the ByLaws. Documents will be viewed and not retained, except for affidavits of eligibility. I WILL read and abide by The Chester Rod and Gun Club Constitution, By-laws, Range Rules and Policies. I will download the current year’s Range Rules from the Club’s web site each year and be familiar with all changes. I UNDERSTAND that I am responsible for anyone using Club facilities covered under my membership. I UNDERSTAND that I am prohibited from giving out any and all combinations, keys or access control badges to Club buildings and grounds. I UNDERSTAND I must have and visibly display my Membership Badge while on Club property, and must present it to any person on the property who requests it. I UNDERSTAND that all members are required to renew their membership by December 31st of each year. I UNDERSTAND that both commercial and non-commercial still, audio, video recording and/or motion picture photography may occur during my presence on CRGC property and as long as I am in the general area, I may be included in such photography/recording(s). Should I wish to be excluded from such photography / recording(s), I understand that it is my responsibility to be aware of photographic / recording activity and remove myself from the area or event being photographed or recorded. Absent such action on my part, I hereby grant CRGC, its agents, volunteers, sponsors, beneficiaries, heirs and assigns the right to use my photographic image and audio/video recording(s) in the promotion of the shooting sports or CRGC in general as it chooses in its sole discretion without compensation. I UNDERSTAND that any misrepresentation on this application will result in termination of my membership without any refund of paid fees. I UNDERSTAND and agree that my use of Chester Rod and Gun Club ranges or participation in Club activities is voluntary and represents a possible hazard to myself and guests. I am responsible to read, understand, and obey all Club and range rules. I assume all such risks freely and further hold all persons and/or business, associated with any event or contest held on Club premises that I may participate in, to be blameless in the case of injury and/or death during such event or contest. I UNDERSTAND that by providing my/our e-mail address(es) I/we agree to allow the Club to add my/our e-mail address(es) to the Club’s e-mail list(s) and to send me/us e-mail notifications based on my/our configured preferences. The Club’s e-mail alerts will be used for club business only and the Club will not divulge your email address(es) to anyone outside the Club without your permission. I/We complete and sign this application to Chester Rod and Gun Club knowing that my / our signature(s) constitute(s) my / our knowledge and understanding of, acceptance of, and agreement to ALL of the above statements. I / We further state that the information herein is to the best of my / our knowledge and ability to be true and correct. My / Our acceptance shall remain in force so long as I / We remain a member of the Club. My / Our drawn or typed Digital Signature(s) on this or any renewal membership application(s) delivered in electronic format shall have the same effect and force as my / our written signature(s). Primary Member Signature * Clear Select the pencil icon to draw your signature or the keyboard icon to type your signature. Spouse/Partner Member Signature * Clear Select the pencil icon to draw your signature or the keyboard icon to type your signature. Submission Date * If you have not previously presented documentary evidence that you are not prohibited from owning firearms you must do so either in person to a CRGC Officer or Director or by uploading your document here. For a list of acceptable types of documentary evidence, please see the New or Renewing Membership pages on the CRGC website. Upload Primary Member Documentary Evidence Drop a file here or click to upload Choose File Maximum upload size: 1MB Upload Spouse/Partner Documentary Evidence Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Payment Info Subtotal: Service Hrs Discount CRGC Officer Discount Primary Work Hrs S/P Work Hrs Discount Type Payment Method * PayPal or Credit Card Check via US Postal Service PayPal or Credit Card payments are charged an additional $5 Processing Fee.A PayPal account is not required to use the PayPal Payment Service. At the PayPal login screen click the Pay with Debit or Credit Card option if you do not have or do not want to use a PayPal account. Processing Fee Total Due: Officer's Total Due: Administrative Information Service Hours Discount Officer Discount Processing Fee Submit If you are human, leave this field blank.