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MEMBERSHIP APPLICATION FORM

3/F Building B, Philsports Complex, Meralco Ave., Pasig City, Philippines 1605 Website :www.PNSA.org.ph

Personal Information
Name Current Address Nick Name Date of Birth Place of Birth Gender __Male __Female Tel No. ____________ Mobile No. ____________ Civil Status Email Address Citizenship Blood Type Name of Spouse
(If minor, Parents or Guardians Name)

Recent Photo 2 X 2 (Preferably White Background)

MM / DD / YYYY

Educational Attainment School High School ________________________ College ________________________ Post Graduate ________________________
Person to Contact in Case of Emergency

Year Graduated _____________ _____________ _____________

Employer/ Company / Business

Position

Name Address

Tel. No. E-mail Address Signature (To be printed on ID) Please keep signature inside the box

Registered Firearm Details

Brand Model Serial No License No

Member of any shooting club?

Yes

No Discipline Pistol Rifle Shotgun

Name of club: _______________________________

Have you ever been convicted of ANY VIOLATION OF PENAL LAW or in ANY ADMINISTRATIVE PROCEEDINGS other than minor traffic violations? YES NO Details, if Any ______________________________________________________________________________________________________ I certify that the foregoing answers are true and correct to the best of my knowledge, belief, and ability that any falsehood entered herein will be ground for denial of my application. If already admitted, such will be ground for automatic revocation of my membership. I pledge to abide by all the rules and regulations as promulgated by the by-laws and those that may be issued by the board of directors from time to time. Signed this _________ day on ______________ 20____ at _________________________________________________________ Fees as of August 2011: Standard Fee New member PHP 1,000.00 Annual Fee* PHP 800.00 ________________________________ Signature (Parent or Guardian if minor) Government Employees PHP 750.00 PHP 600.00 Military/Police PHP 500.00 PHP 400.00 Foreigners PHP 2,000.00 PHP 1,500.00 Students PHP 500.00 PHP 400.00

* Payable every January after the first year of membership

Requirements: 1. Duly accomplished Application Form; 2. 2x 2 ID Picture 3. Photocopy of Valid ID (Drivers License, Firearm License, Passport, Student ID, SSS ID, etc) 4. Payment of Application Fee