Membership Application

This form is for applicants who have been invited by the Prince Edward Rod & Gun Club to complete a formal membership application. If you have not yet been invited to apply, please complete the Membership Wait-List Application first.

Applicant Information

First Name *

Last Name *

Street Address *

City *

Province *

Postal Code *

Phone / Cell Number *

Email *

Licensing & CSSA Status

PAL # *

PAL Expiry Date *

PAL Status *

Other Club Affiliations (optional)

CSSA # *

CSSA Expiry Date *

Your CSSA Membership # will also be your PERGC membership #.
Only paid-up members with a valid CSSA membership are eligible to use facilities and ranges.
Members must renew their own CSSA membership directly through CSSA, either on the CSSA website, by phone at 1-888-873-4339 or 905-720-3142, or by email at info@cssa-cila.org.
Restricted applicants must complete Club Level Handgun Training before using handgun ranges without the presence of a Club Level Instructor.

Membership Type

Select Membership *

Membership dues are $200.00. Family Membership includes spouse and family under 18 years of age and attending school.

Please complete the family member information below for each spouse or family member included in the Family Membership. Family Member 1 is required when Family Membership is selected.

Family Member 1

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status *

Family Member 2

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status

Family Member 3

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status

Family Member 4

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status

Family Member 5

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status

Family Member 6

First Name *

Last Name *

CSSA # *

CSSA Expiry Date *

PAL / Minor Licence

PAL / Licence Expiry

PAL / Licence Status

Club Participation

PERGC relies on support from the membership to help with ongoing maintenance, projects, and club level training.

Are you willing to be contacted by the club for work events or maintenance required at the club? *

Agreement, Signature & Orientation

Before submitting this application form, you must print or save your Membership Application Summary by following the instructions below.
You will not be able to generate this summary after submission. If you change any information after printing or saving the summary, please print or save a new copy before submitting.

I hereby apply for membership in the Prince Edward Rod & Gun Club. I agree to follow all rules and regulations as set out in the Prince Edward Rod & Gun Club Rules & Bylaws, and I will obey all range rules. I understand that all membership applications are subject to review and approval by the Club Executive.

Orientation and payment: No payment is required when submitting this online application. If your application proceeds, payment will be collected in person at the orientation meeting by E-transfer or cheque. Your membership card will be issued once payment has been received and matched to your application.

I have read and agree to the Prince Edward Rod & Gun Club Rules & Bylaws and all range rules. I understand that this application is subject to Executive review and approval. *

Step 1 — Print or Save Your Membership Application Summary

Click the button below to generate your summary. Print it or save it as a PDF before submitting this form.
Bring the signed copy with you to your orientation meeting.

Step 2 — Confirm Before Submitting

I have printed or saved the Membership Application Summary and understand that a signed copy with my hand-written signature must be brought to the orientation meeting.

Step 3 — Submit Your Membership Application

Membership Application Summary

Applicant Information

Name:

Email:

Phone:

Address:

Membership Type:

Willing to be contacted for work events or maintenance:

Licensing & CSSA Status

PAL #:

Agreement accepted:

I confirm that the information submitted in my online PERGC Membership Application form is accurate.
I agree to follow the Prince Edward Rod & Gun Club Rules & Bylaws and all range rules.
I understand that this application is subject to review and approval by the Club Executive.

Applicant Hand-written Signature: ______________________________________

Signature Date: ______________________________________

Orientation & Payment

No payment is required with the online application.
If this application proceeds, payment will be collected in person at orientation by E-transfer or cheque.
Membership card issuance is completed once payment has been received and matched to this application.

Club Use Only — Orientation Sign-Off

Officer Name: ______________________________________

Officer Position: ______________________________________

Officer Signature: ______________________________________

Date: ______________________________________