Dear Applicant,

Thank you for your interest in our club. In your request for membership we require some information. Your help in filling out this application will help us make a better decision upon accepting you as a member. Please answer ALL questions. All information is kept confidential and is not used in any way except to determine eligibility for membership.

PERSONAL INFORMATION:

Name:

Address:

State: Zip Code:

Occupation:

Expiration date or life member.

City:

Birthdate:

Cell Phone Number:

Home Phone Number:

e-mail Address:

NRA Number:

As an NRA affiliated club, individual NRA membership is to be maintained by all LPRC members and prospective members.

Prospective members must submit to a background check; Federal and State, either from the Fairfield County Sheriff’s Office or another office from the Ohio Attorney General’s approved list, clear of any violations of law restricting possession of firearms. In lieu of a background check, a prospective member may provide evidence of eligibility such as, but not limited to, an FFL, C&R license, an Ohio CHL or a CHL/CCW permit from a state that has reciprocity with Ohio. Additionally, a prospective member may provide proof of employment that would require a background check and possession of firearms as part of their employment. This would include, but not limited to, Police Officers, Sheriff or Sheriff Deputy. The cost of the background check is the responsibility of the prospective member. The background check documentation shall be returned to the applicant after review by the membership committee.

We are not a commercial venture. Our club is maintained and cared for by the labor and financial help of the membership. The By-Laws of the club state that you will be required to help share in these responsibilities. Are you willing and able to fulfill these requirements? YES No

Club Use: 1st meeting: 3rd meeting: 2nd meeting:

Safety Course – Date: Instructor:

Background Check Verified By: BCI on: CHL Expires on: LE on:

Approved by Membership Committee:

Voted on and accepted by Membership on

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Questions for Applicants:

1. Have you ever been convicted in any court of a felony offense? YES NO

2. Are you under indictment for a felony offense? YES NO

9. Have you ever renounced your United States citizenship? YES NO

10. Are you an alien illegally in the United States? YES NO

Upon acceptance to membership into the Lancaster Pistol & Rifle Club, I agree to abide by all rules and regulations as set forth in the club by-laws, contribute to fellowship with other members and assist in maintenance of club property and grounds with the purpose of maintaining and building a safe and pleasurable association. By signing below, I confirm that I have read and understand the LPRC bylaws and that I am legally able to possess a firearm.

Signed: Date:

Notary Public: Date:

Ohio NRA Charter #5851 CMP #24176 Application for Membership Revised 5/13/2019

3. Is there an outstanding warrant of arrest pending against you from any jurisdiction? YES NO

4. Are you an unlawful user of or addicted to any controlled substance (as defined in section 102 of theControlled Substances Act, codified at 21 U.S.C. § 802)? WARNING: The use or possession of marijuanaremains unlawful under Federal law regardless of whether it has been legalized or decriminalized formedicinal or recreational purposes in the state where you reside. YES NO

5. Have you ever been adjudicated legally incompetent, mentally incapacitated or been involuntarilycommitted to a mental institution? YES NO

NO

NO

6. Have you ever been discharged from the Armed Forces under dishonorable conditions? YES

7. Is there an outstanding protective or restraining order against you from any court? YES

8. Have you ever been convicted in any court of a misdemeanor crime of domestic violence? YES NO

The Lancaster Pistol & Rifle Club does not discriminate on the basis of race, color, national or ethnic origin, sex, sexual orientation, disability, veteran status or age in the administration of any of its programs or in membership. Note to Prospective Members: 1) you must attend 3 meetings 2) bring your application to every meeting 3) Attend Safety/Orientation course - Please ask for contact information for the Instructor when you attend your first meeting. 4) Remember to have this application notarized.

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