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]