Membership Waitlist Form - Prince Edward Rod & Gun Club

Membership Waitlist Application

This is not a membership application. If you wish to be notified of future membership opportunities, please complete the following Wait List Application Form.

You will only be contacted when membership opportunities become available. If a membership opportunity becomes available and you wish to proceed, a formal membership application, full payment, and CSSA membership will be required.

Applicant Information

First Name *

Last Name *

Date *

Street Address *

City *

Province *

Postal Code *

Secondary Residence / Local Prince Edward County Address

Phone Number *

Email Address *

Occupation

Family Membership Interest

Are you interested in a family membership? *

Please list the family members who may be included in a future family membership application. Family Member 1 is required when “Yes” is selected.

Family Member 1

First Name *

Last Name *

Age *

Relationship *

Family Member 2

First Name

Last Name

Age

Relationship

Family Member 3

First Name

Last Name

Age

Relationship

Family Member 4

First Name

Last Name

Age

Relationship

Family Member 5

First Name

Last Name

Age

Relationship

Family Member 6

First Name

Last Name

Age

Relationship

Firearms Licence Status

Please answer each licence status below. If you do not currently hold a Possession and Acquisition Licence (PAL), choose “No” for all three licence status questions.

Do you have a PAL? *

Restricted? *

Prohibited? *

Primary Shooting Discipline

Please rank your areas of interest using 1, 2, 3, etc. or N/A where not applicable.

Trap *

Rifle *

Handgun *

Black Powder *

Archery *

Club Background & References

Current or Previous Gun Club Memberships

Additional Firearm Training

PERGC Members in Good Standing

Club Participation

PERGC relies upon support from the membership to help with ongoing maintenance, projects, and club-level training. Are you able and willing to donate up to 8 hours per year to help support these types of efforts? *