Rm. 11-C Robinson Tower II, J. Bocobo, cor. Pedro Gil St., Malate, Metro Manila (IMF,1) INDIVIDUAL MEMBERSHIP FORM _________________________________________ FAMILY NAME __________________________________ MIDDLE NAME DATE OF BIRTH: ___________________________________ _______________________________ FIRST/GIVEN NAME AGE: ______________ SEX: Male _______ Female:________ COMPLETE HOME ADDRESS: ______________________________________________________________________________________________________________ No. and Street Name / Name of Building /Condo/Subdivision Barangay City / Province ______________________________________________________________________________________________________________ OCCUPATION / POSITION NAME OF COMPANY/ORGANIZATION COMPLETE OFFICE/BUSINESS ADDRESS: ______________________________________________________________________________________________________________ No. and Street Name / Name of Building /Condo/Subdivision Barangay City / Province LANDLINE No. : __________________________________ MOBILE No.:___________________________________ EMAIL ADDRESS: _________________________________________________________ STATUS: __________________________ ______________________________________________________________________________________________________________ NAME OF GUN CLUB ADDRESS IREARM DETAILS: ______________________________________________________________________________________________________________ TYPE (Pistol/Revolver) MAKE/MODEL CALIBER SERIAL NUMBER LICENSE NUMBER Number of years as a gun club member /Sports Shooter: ______ Number of years as a licensed gun owner: ________ I hereby certify that the above information that I provided are current, true, and correct and that I have attached a recent 2x2 colored ID Picture, a copy of my current firearm license, and the membership fee/annual dues. I understand that any false information declared shall be grounds for the rejection of my application and/or expulsion from the PSMOC: _____________________________________________ PRINTED NAME & SIGNATURE OF APPLICANT ENDORSED BY: ___________________________________________________ PRINTED NAME & SIGNATURE OF GUN CLUB SECRETARY ___________________________________________________ PRINTED NAME & SIGNATURE OF GUN CLUB PRESIDENT APPROVED BY: ___________________________________________________ PSMOC SECRETARY Individual Membership Fee: 500 Pesos Pesos Website: www.psmoc.org.ph Contact No.: (Globe) 09158150927 , (Sun) 09226904704 ___________________________________________________ PSMOC PRESIDENT Individual Annual Dues: 1000 Email Address: [email protected] [email protected]
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