Junior Event Application printable pdf download

Centralia Rifle Club & Junior Division

A Washington not-for-profit corporation

908 Johnson Road, P.O. Box 465, Centralia, WA 98531

(360) 736-1003

Junior Event Application

DATE: ___________________

Child’s Name _________________________________________________________________________

(Last, First, Middle)

Date of Birth: ________________________ Sex: Male__ Female__

School Attending_______________________

Address: ________________________________________________ City: ___________________ Zip: _____________

Parent’s Name:

_____________________________________________________________________________________

(Last, First, Middle)

Address: ________________________________________________ City: ___________________ Zip: _____________

Phone #: Home: ________________________ Work: ______________________ Cellular: _______________________

E-mail address(es): _________________________________________________________________________________

NRA Membership No. of Child(ren) if applicable ___________________ Expire date: _____________

List previous marksmanship training and experience: _______________________________________________________________

_________________________________________________________________________________________________________

List NRA rating or classifications: ________________________________________________________

_________________________________________________________________________________________________________

The following information is requested in order to comply with requirements of the U.S. Department of Civilian Marksmanship.

Applicants are not required to answer. Has this child ever been arrested, other than for a minor traffic violation? ____Yes ____No If

so, state date, county, charge and outcome:

___________________________________________________________________________________________________________

Junior Membership Application 2004 Revised 2005

Junior Event Application