First Name

Last Name

Street Address

Apt./Unit No.:

City

Province

Phone Number

Postal Code

Birth Date (yy/mm/dd)

Email Address

PAL (Posession Aquisition Lic.) #:

Expiry Date (yy/mm/dd)

Select one: Select one: Non Restricted Restricted

Emergency Contact Name

Emergency Contact Phone Number

Relationship

Agreement Agreement I have read, understood and agree to be bound by the police, rules and regulations of the East Coast Target Shooters Gun Club. I understand that my membership may be cancelled without refund, should I breach the rules and by-laws of the club. All memberships are final sale, no refunds.

Enter Your First and Last Name

Date (yy/mm/dd)