Annual Membership Form

Date applying……………………………

Renewal or New Member (delete as applicable)

Name……………………………………………………………………………………………………………………………………………………………

Address…………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………….Postcode………………………………………………………….

Telephone ………………………………………………………………..………………..  Mobile  …………………………………….…………….                                       

Email………………………………………………………………………………………………………………………………………………………………

Shotgun Certificate number ……………………………………………………………….…… Expiry………………………..………………..

CPSA number…………………………… (if no number advise of alternative insurance)……………………………………………….

Disabled member / Able bodied member

Sitting / Standing

I am Currently Registered disabled Yes / No

 Brief description of disability…..……………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………

Proof of disability to be attached if you are a new member or your circumstances have changed. Including:-

Entitlement to any disability allowance / incapacity benefit.

In the absence of the allowances a letter / statement from a practising GP / consultant giving a level of Disability should be provided.

If neither of the above apply and an applicant has an obvious disability the officers of the DSG will look at each case objectively and decide their suitability.

Above a,b & c only applies to new member or those who have not yet supplied the information to the treasurer.

Emergency contact – Name ……………………….………………  Number………………………………………………….

New membership is 30.00 renewal is £15.00 paid to the ‘Disabled Shooters Group’ posted / or by hand to our treasurer  in cash or cheque.

Disclaimer  -  an individual disabled membership will not automatically entitle them to classify as per IPC ( International Paralympic Committee) rules should clay target shooting be accepted.

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Sam Nunn (Secretary)                                         Darrel White (Chairman)                                Adrian Last (Treasurer)

Raewyn                                                                                                                                            Orchid meadow

Shotley Road                                                                                                                                    Chapel Road

Chelmondiston                                                                                                                                  Mendlesham

Ipswich                                                                                                                                             Stowmarket

IP9 1EE                                                                                                                                             IP14 5SQ

Mob. 07808 554686                                                                                                                            tel. 01449 766703


Ema. nuttynunny84@googlemail.com                              chair@disabledsg.co.uk                                          Ema. adrianlast222@btinternet.com

 


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