Membership Application

First Name *

Last Name *

Phone Number *

Date of Birth *

Email Address *

Address Line 1 *

Address Line 2

City *

State *

Zip *

Emergency Contact Name *

Emergency Contact Number *

Please indicate your level of overall shooting, gun-handling, and professional shooting range experience: *

Beginner Intermediate Advanced

Please indicate your level of "tactical" or competitive shooting experience: *

Beginner Intermediate Advanced None

Have you completed any formal firearms training under the direction of a professional instructor? *

Yes No

In which shooting activities are you most interested? *

e.g. target shooting, tactical training, competitive shooting, hunting, long distance

What is your favorite currently owned firearm? *

Have you previously completed a Hunter's Safety Education course? *

Yes No

Have you previously completed a range safety course? *

Yes No

Are you a team-oriented person, willing to help on Range Maintenance Days whenever you can? *

Yes No

Are there any medical conditions we should be aware of? *

If yes, range personnel will discuss with you in person. Please do not list private health information here.

Yes No

Additional information or health related questions or concerns:

Have you read and understand the Rules and Risks of Range 360 Membership? *

Yes No

Do you understand that completing this application questionnaire does not necessarily mean your membership will be approved? *

Yes No

Additional comments, requests, or other considerations for membership:

Range personnel will contact you upon approval of this application and schedule orientation.