Membership Application

Transcription

1 LLC Membership Application Date Date of Birth Name First MI Address City State Zip Home Phone Cell Driver s License State Number Yes No Current member of the U. S. Armed Forces Credentialed Law Enforcement N.R.A. member Current Virginia Concealed Carry Permit If Yes, Permit number Do you possess a copy of VA State Police Form SP-167 (Criminal Record Check) NOTE: Individuals that are on active duty military service, sworn lw enforcement personnel, or that possess current concealed weapons permits in Virginia are not required to present a criminal records check. I certify the above information I have proved is true and correct. I agree to present supporting documentation in order for the representatives of Range 82 to verify my status, and/or anyone wishing to be exempt from the Virginia criminal background check. I further agree to abide by all rules pertaining to membership and safety on the range while on the premises. Applicant signature Date

2 Terms of Membership Member 21 years or older Guest Member dependent(s) under 21 Each member receives 6 guest passes per year. $300 annually $ 16/hour, minimum 1 hour $ 10 each annually. Must be accompanied by member. Active Law Enforcement & Military 10% off, i.e. $270 annually

3 HOLD HARMLESS AGREEMENT Effective DateX County and State: Fauquier, Virginia X FIRST PARTY (Name, Address & Zip Code): SECOND PARTY: Range 82, LLC 4818 Midland Road Midland, VA Activity: Duration of Activity or Date: Recreational Shooting One year Scope of Agreement X This Agreement is mutual and through it each party holds the other harmless and releases the other from all liability arising from the activity involved. When Release Is Effective It is contemplated that the parties may execute this release at different times for convenience sake; however, this release shall not be effective until after all parties, or their lawful agents, have executed the release, then its effective date shall revert back to the date which has been set forth above. In witness whereof the parties have executed this intending it to be effective on the above effective date. X Signature of the First Party Range 82, LLC Signature of the Second Party

4 Range Safety Rules: 1. ALWAYS treat every weapon as if it were loaded. 2. Keep the muzzle pointed in a safe direction. Never point the muzzle at anything you are not prepared to shoot. 3. Never place your finger on the trigger unless you are on target, have made a conscious decision to fire, and know your backstop. 4. All loading and unloading of the weapon system will be done at the firing line at the direction of the Range Master. 5. Do not leave firing line unless permitted/instructed to do so. 6. Eye and ear protection must be worn on the firing line at all times. 7. Do not bend over on the firing line unless instructed to do so. 8. Obey all commands of the Range Master and/or Instructor(s). 9. There will be no smoking within 10 yards of the loading area. 10. Always wash hands before eating, drinking, or smoking. 11. Anyone who sees or hears an unsafe act will call cease fire. 12. All activity stops on the command of cease fire. 13. There will be no tracking of or shooting of wildlife that may appear on or near range. 14. All weapons will be fired into the sand backstop. If you can t see sand, DO NOT discharge weapon. 15. ALL weapons will be unloaded before leaving the firing line. 16. Any individual taking medication, prescribed or over-the-counter, or that has consumed alcohol in less than 12 hours will notify the Range Master. 17. Any injury should be reported immediately to the Range Master. Failure to follow any of the above safety rules will result in the individual being removed from the facility for a period of time determined by the management of Range 82, LLC. Printed NameX SignatureX DateX

5 Please retain for your information: SHOOTING HOURS Saturday, year around 12 Noon - 6 PM 12 PM - 3 PM Pistol & close rifle normally 7-10 yard line 3 PM - 6 PM 50/100/200 yard line Tues., Wed., Thurs (during daylight savings time) 5 PM ½ hour before sunset NO full auto or bump fire Calibers up to.45 handgun,.46 rifle &.54 black powder TO SCHEDULE Call Lee at to schedule time by 10 AM on Saturday & 3 PM during the week.