Web Page: http://www.upperhumberrodandgun.com Email uhrgassoc@gmail.com
Name: __________________________________________ Date of Birth: _____________
Address:__________________________________________________________________
Postal Code: _________________
Telephone: _________________________________ Cell #: _________________
Email: _____________________________________________________________
Have you completed a firearms safety course. Yes □ No □
If so, where was the course completed? Sea Cadets □ Army Cadets □ CNA □ Other
□ Based on the completion of a firearms safety course, please include one of the following.
If you possess firearms or intend to use our ranges you must also include a photocopy of both
sides of your firearms license, as indicated below: (Indicate your choices)
□ Certificate of good conduct (RCMP or RNC) □ Photocopy of both sides of your valid
Firearms License
□ Firearms License #: ___________________________________□ Expiry Date: _________
YOUTH MEMBERSHIP FEES: (Includes $5,000,000 liability insurance)
$45.00 (includes taxes) annually, payable with application or application processing may be
delayed. Membership runs from Feb 01, 2025 through to Jan 31, 2026
Indicate payment type: □ Cash □ Cheque □ Money Order □ Bank Draft
□ Electronic email (send to: uhrgassoc@gmail.com)
Application must be signed and dated by parent/guardian (if applicant under 18)
I hereby give my consent for Youth Membership in the Association.
Parent/Guardian Signature: ___________________________________ Date: __________
Application must be completed, signed and dated by youth applicant for processing.
Signed: _____________________________________ Date: __________________
Note: By signing this application you acknowledge that you have read the Association’s range
rules and regulations and agree to abide by them. Privacy Statement: All membership
application information is confidential and will not be released, except for insurance coverage
purposes and Canadian Firearms Centre requirements, without the signed written consent of
the applicant.
HOME OF THE ALL NEWFOUNDLAND BIG GAME TROPHY COMPETITION
2025 YOUTH MEMBERSHIP
UPPER HUMBER ROD AND GUN ASSOCIATION
177 GOOSE ARM ROAD, DEER LAKE, NL
A8A 3H9
