Become a Member - NKSSA - Northern Kentucky Straight Shooters Association

First name    Last Name   DATE OF BIRTH:

Height:    Weight:     Eye color:     Hair color:

PLACE OF BIRTH:

PHONE #         E-MAIL ADDRESS:

PRESENT ADDRESS:     City:    State:    Zip:
 

PLEASE ANSWER FOLLOWING QUESTIONS YES OR NO.
A POSITIVE ANSWER MEANS REJECTION FROM CONSIDERATION IN CLUB.

1) HAVE YOU EVER BEEN CONVICTED OF A FELONY INVOLVING THE USE OF A FIREARMS OR VIOLENCE?  Yes   No

2) DURING THE PAST 10 YEARS HAVE YOU BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE USE OF A FIREARM OR VIOLENCE?   Yes   No

3) ARE YOU ADDICTED TO ANY NARCOTICS?   Yes   No

4) ARE YOU NOW UNDER INDICTMENT BY OR WANTED BY ANY MUNICIPALITY FOR ANY REASON OTHER THAN A NON VIOLENT MISDEMEANOR?   Yes   No

WHAT IS YOUR PRIMARY SHOOTING INTEREST?  RIFLE      PISTOL      SHOTGUN      BLACK POWDER      ARCHERY

YOUR OCCUPATION:

PLACE OF EMPLOYMENT:

ADDRESS:    City:  State:    Zip:

ARE YOU A MEMBER OF ANY OTHER SHOOTING ORGANIZATIONS?  Yes   No 

IF SO PLEASE GIVE THEIR NAMES:

TYPE OF MEMBERSHIP:   PLEASE PICK ONE

Single   $35.00 Family   $45.00  Spouse/Domestic Partner Name:       Adult Children 18-21 years of age (AT SAME ADDRESS) now included in Family Membership. SENIOR Over 62 years of age (or Handicapped)   $30.00

TOTAL AMOUNT PAID  $

(By entering my name below) I HEREBY AFFIRM ALL STATEMENTS ON THIS APPLICATION TO BE TRUE TO THE BEST OF MY KNOWLEDGE,
AND GIVE THE NKSSA AUTHORITY TO VERIFY THE SAME WITH ANY AGENCY THEY DEEM NECESSARY.
BY SIGNING THIS APPLICATION I HEREBY AGREE TO ABIDE BY THE RULES, REGULATIONS AND BY-LAWS OF THE NKSSA INC.
AS THEY ARE AND AS THEY MAY BE AMENDED FROM TIME TO TIME.

E-SIGNATURE (Type Name)