Guide & information sheet for membership to east bangor sportsman’S
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GUIDE & INFORMATION SHEET FOR MEMBERSHIP TO EAST BANGOR SPORTSMAN’S ASSOCIATION 1. This front cover sheet is intended to explain what information needs to be supplied to become a member of the East Bangor Sportsman Association starting with the 2013 membership year. 2. This new procedure for membership status is necessary so that all members feel safe when using the facility and to know that each member is of good character and citizenship, to come into compliance with insurance regulations and to operate in a more efficient manner. 3. The second page of this document is the East Bangor Sportsman’s Association application page. On this page all information needs to be filled in that applies to the person pledging to become a member for 2013. 4. The third page (rear side of second page) is the listing of the rules of the club. These rules are to be used as a guide and to be strictly adhered to throughout the membership year. You must read, understand and acknowledge that you will follow these rules by signing this page at the designated area. 5. The last page (if required) is the State Police Background Check form. There will be a $10.00 fee paid to the state in addition to the membership fee for the year if you do not meet the requirements listed on page #2 of this document. Please note the requirements listed on page #2 that COULD make you exempt from this background check are; a current carry-conceal permit in Pennsylvania or a New Jersey Firearms Owner ID card, concealed carry permits from other states would also be acceptable. The membership committee also reserves the right to turn down or revoke membership to anyone who is deemed unworthy of membership or who violates any club rules throughout the year.
East Bangor Sportsman's Association Membership Application Name (Print Legibly): ______________________ ___________________ _____
Last First
MI Address: _______________________________________________________ City: _________________________ State: ______ Zip: ___________ Phone #: ____________________ Email Address: ______________________________ NRA Member? Yes - Number: ______________ No: ____ Present member (renewal): _____ New Membership: _____ Signature: __________________________ Date: ____________ Pennsylvania residents - Include a photocopy of drivers license and Concealed Carry Permit below. If no carry permit, submit PA State Background Check form to address on form. New Jersey residents - Include a photocopy of drivers license and Firearms Owners ID card. All other states - Include photocopy of Drivers License and Carry permit. NOTE: No membership will be issued without information requested above and signatures on this page and range rules form acknowledging information is correct and has been understood. EBSA has the right to reject or revoke membership to individuals. _________________________Attach Photocopies below____________________________
East Bangor Sportsman’s Association Range Rules: 1. Members ONLY (children under 16 Exempt when accompanied by an adult member 18 or older) 2. Paper Targets ONLY (NO Glass, gas cylinders, home electronics, etc.) 3. NO automatic firearms and NO .50 BMG rifles. 4. Use of Rifles (over .22 rimfire) and Shotguns on the Pistol range is PROHIBITED! 5. DO NOT place targets above the backstop!!!!! 6. Please help to keep your range clean, place all trash in barrel before leaving the range. 7. Please be courteous when others are waiting to use the range and limit time on the range to 45 minutes. 8. Anyone found deliberately damaging range fixtures or equipment will be subject to expulsion and criminal charges! 9. The use of alcohol and drugs while shooting is strictly prohibited. 10. Range Hours are Sunrise to Sunset Monday – Saturday, 9am to Sunset Sundays. 11. Hunting & trapping (in season) permitted by Members ONLY. 12. In case of EMERGENCY the address of the range is: 152 Bangor Vein Road _______________________________ ____/_____/______ Signature Date _______________________________ Witnessed by SP 4-164 (7-2009)
PENNSYLVANIA STATE POLICE REQUEST FOR CRIMINAL RECORD CHECK
This form is to be completed in ink by the requester – (information will be mailed to the requester only). If this form is not legible or not properly completed, it will be returned unprocessed to the requester. A response may take four weeks or longer. Warning: A person commits a misdemeanor of the third degree if he/she makes a written false statement, which he/she does not believe to be true. TRY OUR WEBSITE FOR A QUICKER RESPONSE https://epatch.state.pa.us NAME/ REQUESTER
ADDRESS
CITY/STATE/ ZIP CODE
CONTACT TELEPHONE NUMBER (INCLUDING AREA CODE)
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NAME/SUBJECT OF RECORD CHECK (FIRST)
(MIDDLE)
(LAST)
MAIDEN NAME AND/OR ALIASES
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM/DD/YYYY)
SEX
RACE
The Pennsylvania State Police response will be based on the comparison of the data provided by the requester against the information contained in the files of the Pennsylvania State Police Central Repository only REASON FOR REQUEST: All requests $10.00 ***MAKE ALL MONEY ORDERS PAYABLE TO: COMMONWEALTH OF PENNSYLVANIA *** ◄◄◄◄◄◄CHECK BOX THAT MOST APPLIES TO THE PURPOSE OF THIS REQUEST►►►►►►
INTERNATIONAL ADOPTION - INTERNATIONAL ADOPTION MUST BE NOTARIZED. ADOPTION (DOMESTIC) EMPLOYMENT/SCREENING PASSPORT ATTORNEY FOSTER CARE PRIVATE INVESTIGATIONS BANKING HEALTHCARE SOCIAL SERVICES BAR ASSOCIATION HOUSING TENANT CHECK CHURCH INSURANCE LICENSE VISA CHILD CARE MENTAL HEALTH VOLUNTEER AMBULANCE/FIREFIGHTER EDUCATION NURSE AID TRAINING VOLUNTEER ELDER CARE OTHER _________________ EMERGENCY MANAGEMENT ACCESS & REVIEW - (NOT FOR EMPLOYMENT PURPOSES. MUST BE MAILED INTO THE CENTRAL REPOSITORY.)
AVAILABLE ONLY TO SUBJECT OF RECORD OR LEGAL REPRESENTATIVE WITH LEGAL AFFIDAVIT ATTACHED FOR THE PURPOSE OF REVIEWING YOUR CRIMINAL HISTORY. FOR CENTRAL REPOSITORY USE ONLY CONTROL NUMBER AFTER COMPLETION MAIL TO: PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY – 164 1800 ELMERTON AVENUE HARRISBURG, PA 17110-9758 Local Number 717-425-5546 1-888-QUERYPA (1-888-783-7972) DO NOT SEND CASH OR PERSONAL CHECK CHECK ONE BLOCK INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY – ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF $10.00, PAYABLE TO: “ COMMONWEALTH OF PENNSYLVANIA ” THE FEE IS NONREFUNDABLE FEE EXEMPT-NONCRIMINAL JUSTICE AGENCY – NO FEE Homeland Security is Everyone’s Responsibility - Pennsylvania Terrorism Tip Line 1-888-292-1919 East Bangor Sportsman's Association 824 Washington Blvd Bangor, PA 18013 Membership Document Outline
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