Membership Application URLThis field is for validation purposes and should be left unchanged.Your Name(Required) First Last Street AddressCity, State and Zip / Postal CodeYour Email Address(Required) Email Address Confirm Email Address Home Number(Required)Mobile Number(Required)DOB(Required)NRA Member NumberType of shooter Pistol Rifle Shotgun Employer Company NameEmployer Phone Number(Required)Below please list 3 references who have known you for at least 5 years.Reference 1 NameReference 1 PhoneReference 1 Email Reference 2 NameReference 2 PhoneReference 2 Email Reference 3 NameReference 3 PhoneReference 3 Email Sponsor Name Please attach a photo of Driver's License & Pistol PermitMax. file size: 256 MB. SignatureSignature Date MM slash DD slash YYYY Notification and Authorization to Release Criminal Information(Required) I consent to the followingNotification The membership for which I am being considered requires me to consent to a criminal background check as a condition of membership. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided. Authorization I hereby authorize WHRG to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist WHRG in collecting this information. Validity Screening Solutions has been secured as a third party vendor (consumer reporting agency) to assist WHRG in collecting and verifying information. I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to membership. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness. I hereby apply for membership in the Washington Hollow Rod & Gun Club, Inc. and agree that if I am voted into membership, I will abide by all of its regulations & By-laws. I further certify that all the forgoing answers are true and that any false statements result in the forfeiture of membership and fees. Initiation is $250Full membership $225*Prices subject to change Processing fee $25
