GLEN COVE PBA PISTOL AND RIFLE ASSOCIATION
By signing this application, I acknowledge that I have read and understand the rules, regulations, and policies of the Glen Cove PBA Pistol and Rifle Association. I understand that the primary purpose of my membership is to allow for convenient access to the facility primarily for firearms instruction and training but that occasional social/recreational activities may be held. I also give the Glen Cove PBA Pistol and Rifle Association permission to collect information regarding the validity of my United States citizenship, criminal record, and pistol permit information. I have also answered all questions truthfully and to the best of my knowledge.
I understand that any false statements made herein will result in immediate termination of my membership and I may be reported to the appropriate governmental authorities for investigation and/or possible prosecution for wrongdoing under applicable law.
SIGNATURE _______________________________ NAME
(Printed)______________________________DATE _________/__________/__________
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DO NOT WRITE BELOW THIS LINE INITIATION FEE: __________________________ |
DATE RECEIVED _______/________/________ |
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ANNUAL DUES: __________________________ |
DATE RECEIVED _______/________/________ |
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MEMBERSHIP # __________________________ |
ID CARD# _______________________________ |
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ID CARD RECEIVED ___________ (INITIAL) |
DATE RECEIVED _______/________/________ |
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KEY FOB YES/NO |
DATE RECEIVED _______/_________/_______ |
We are still waiting on the city council to approve the lease. as of 6/15/2024
