New or Renewing Member Do you hold a current firearms license? Yes No New Member  Renewing Member Current Member Number License Number: If no, are you in the process of applying for your firearms license? Branch Details Yes No Harvey Moora Pegasus (Lancelin) Three Springs Is your firearms license for CLUB USE ONLY? Wannamal Echidna Park Yes No Perth Metro - Wanneroo & Whiteman Park Please email this form to your club. Gender Declaration Male Female I hereby declare, that all information I provided on this form is true and correct. I also declare that I am not subject to any court order prohibiting Personal Details possession or use of a firearm, and have not had a Full name and residential address personal firearms license cancelled or revoked in Name: any State or Territory of the Commonwealth of Australia. I also agree to abide by SCA Constitution and Code of Conduct, WAF&GA bylaws and rules Residential address: of Association and Branches. Signature of Applicant or Guardian Postcode: Date: Postal Address: (if same as residential address write “As Above”) Signature of Junior (if under 18) Must also include Postcode: signature of guardian. Date of Birth: Date: Contact Details Home Phone: Personal Information Disclosure Mobile Phone: The SCA & WAFG&GA protects the privacy and security of information provided by you. By Emergency Contact Name: completing this form, you agree to the use of your personal information to be disclose to SCA, Emergency Contact Number: WAF&GA & Clubs affiliated with SCA & WAFG&A. This information is used to process your Email Address: registration details and assist in sending out of magazines to your nominated address. We do not disclose your personal information to any third party without your consent NB: If your firearm is for Club Use Only this form MUST be emailed through to the State Firearms License Details
New or Renewing Member New Member Renewing Member  Current Member Number Branch Details Harvey Moora Pegasus (Lancelin) Three Springs Wannamal Echidna Park Perth Metro - Wanneroo & Whiteman Park Gender Male Female Personal Details Full name and residential address Name: Residential address: Postcode: Postal Address: (if same as residential address write “As Above”) Postcode: Date of Birth: Contact Details Home Phone: Mobile Phone: Emergency Contact Name: Emergency Contact Number: Email Address: NB: If your firearm is for Club Use Only this form MUST be emailed through to the State Firearms License Details Do you hold a current firearms license? Yes No License Number: If no, are you in the process of applying for your firearms license? Yes No Is your firearms license for CLUB USE ONLY? Yes No Please email this form to your club. Declaration I hereby declare, that all information I provided on this form is true and correct. I also declare that I am not subject to any court order prohibiting possession or use of a firearm, and have not had a personal firearms license cancelled or revoked in any State or Territory of the Commonwealth of Australia. I also agree to abide by SCA Constitution and Code of Conduct, WAF&GA bylaws and rules of Association and Branches. Signature of Applicant or Guardian Date: Signature of Junior (if under 18) Must also include signature of guardian. Date: Personal Information Disclosure The SCA & WAFG&GA protects the privacy and security of information provided by you. By completing this form, you agree to the use of your personal information to be disclose to SCA, WAF&GA & Clubs affiliated with SCA & WAFG&A. This information is used to process your registration details and assist in sending out of magazines to your nominated address. We do not disclose your personal information to any third party without your consent
wafga-membership-app-form-aug2017.docx