NORTHERN KENTUCKY STRAIGHT SHOOTERS ASSN., INC. CRITTENDEN, KENTUCKY
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 FULL $35.00 Full + Spouse $45.00 Spouse Name: ASSOCIATE 18-21 (AT SAME ADDRESS) $10.00 OVER 62 SENIOR CITZEN OR HANDICAPPED $30.00 TOTAL AMOUNT to be PAID $
TYPE OF MEMBERSHIP: PLEASE PICK ONE
TOTAL AMOUNT to be 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)