Reg2 – Mission & District Rod & Gun Club

User Details

Username* Usernames cannot be changed.

First Name* This first name MUST match the name on your official government ID (DL / PAL / PASSPORT).

Last Name* Your last name MUST the exact name found on your officel government ID (DL / PAL / PASSPORT).

Nickname

Address*

City*

Province* Select Province

Postal Code*

Date of Birth*

Phone* Required phone number format: ###-###-####

Mobile Phone Required phone number format: ###-###-####

E-mail*

Email List Op-In

The MDRGC has implemented an email system to allow effective communication with our members. You can decide here whether to be part of this mailing list.

Remember, this is the best way to stay connected for important notices from the club.

We will NEVER sell your information to a third party for marketing purposes.

Email Subscription Service Opt-In

Possess PAL* If you are purchasing a membership that allows for the use of a firearm, you must possess a PAL. Please state yes or no.

PAL Number - Primary* Current Valid PAL Number of the Primary Member. DO NOT USE NUMBERS TO RIGHT OF DECIMAL.

PAL Expiry Date - Primary* Expiry date of PAL for Primary Member.

PAL Restricted - Primary* Does the Primary Member have an RPAL?

Volunteer* PLEASE READ CAREFULLY. We are a member run club and Volunteers are essential to our success. If you don't wish to volunteer, we ask for a minimum donation in lieu of volunteering. Please note the amount will be requested when you are purchasing your membership. This is simply for us to know what areas if any you are able to assist with.

Volunteer Areas of Interest*

Notes Specify Other

Disciplines of Interest*What shooting disciplines are you interested in?

Membership Type:* Select the type of Membership you will be purchasing. This will allow you to enter the names of the family members on the membership if needed. PLEASE USE THE NAME AS IT IS FOUND ON YOUR OFFICIAL PICTURE ID (DL / PAL / PASSPORT).

Spouse Full Name Full name of Spouse on a Family or Senior Couple membership. MUST BE EXACTLY AS SHOWN ON GOVERNMENT ID (DL / PAL / PASSPORT)

Spouse Birthdate Please provide the birthday of the Spouse on any Family type of membership

Spouse PAL Number PAL Number of the Spouse on Family or Senior Couple Membership if they posses one

Spouse PAL Expiry Date PAL Expiry Date of your Spouse

Is Spouse's PAL Restricted Do you possess a Restricted PAL?

Full Name of First Dependent Full name of First Dependant EXACTLY AS IT APPEARS ON GOVERNMENT ID.

First Dependent Birthdate REQUIRED INFO: If missing info this could delay the processing of your application. Please provide the birth date of the your first dependent under 18 years of age if on a family membership.

Full Name of Second Dependent Full name of second dependent on a Family membership. This must EXACTLY MATCH THE NAME ON GOVERNMENT ID.

Second Dependent Birthdate REQUIRED INFO: If missing info this could delay the processing of your application. Please provide the birth date of the your 2nd dependent under 18 years of age if on a family membership

Full Name of Third Dependent Full name of third dependent on a Family membership. MUST EXACTLY MATCH NAME ON GOVERNMENT ID.

Third Dependent Birthdate REQUIRED INFO: If missing info this could delay the processing of your application. Please provide the birth date of the your 3rd dependent under 18 years of age if on a family membership

Full Name of Fourth Dependent Full name of third dependent on a Family membership. MUST MATCH EXACTLY THE NAME ON YOUR GOVERNMENT ID (DL / PAL / PASSPORT).

Fourth Dependant Birthdate REQUIRED INFO: If missing info this could delay the processing of your application. Please provide the birth date of the your 4th dependent under 18 years of age if on a family membership

Full Name of Fifth Dependent Full name of fifth dependent on a Family membership. MUST MATCH EXACTLY THE NAME ON YOUR GOVERNMENT ID (DL / PAL / PASSPORT).

Fifth Dependant Birthdate REQUIRED INFO: If missing info this could delay the processing of your application. Please provide the birth date of the your 5th dependent under 18 years of age if on a family membership If you have MORE THAN 5 dependents, please contact the Registrar so we can help you get them entered (:

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