Membership Form

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Title:   * Initials:    Surname:   
Full Names: Birth Date: Nickname:   
Id. Number: Previous Membership #
Postal Address:
* Certain Conditions exist for keeping old Number
 Postal Code:  Language:
Street Address:  Suburb:
Tel.  (Home)   (Work)
Fax:       Cellular:
E-mail address:

Send Correspondence via e-mail?    

Name, Initials. (Surname if not the same) Relation (Son, Spouse etc.) Id. No or Birth Date (YYYY-MM-DD) (Compulsory)
Recruited by:   Initials:   Surname: 
Membership #:  (Membership Number Optional if not know)

(Please complete second page)


I acknowledge that I will have no claims whether for damages or otherwise against Buffalo River Shooting Club or any of its directors, agents or servants arising out of loss of life and/or property damage and whether or not caused by the negligence, gross or otherwise of Buffalo River Shooting Club or any of the aforesaid persons, or as a result of any defective firearm or ammunition (including reloads) having been issued to me by Buffalo River Shooting Club and I hereby irrevocably waive and abandon all such claims. I further confirm that this waiver will be binding on my estate, executors, dependants or assigns and that Buffalo River Shooting Club and the aforesaid persons are hereby released from any duty of care towards me.

I hereby indemnify and shall keep indemnified Buffalo River Shooting Club, its directors, agents and servants and hold each of them harmless from and against all and any claims, loss, demands, liability, cost and expenses of whatsoever nature (including legal costs) which may be brought against Buffalo River Shooting Club its directors, agents and servants by any person whomsoever by any act or omission of whatsoever nature and whether amounting to negligence (including gross negligence) or otherwise on my part and/or breach by me of any of Buffalo River Shooting Club’s range orders and/or use by me of Buffalo River Shooting Club’s premises.

I acknowledge and confirm that my use of Buffalo River Shooting Club’s premises will be entirely at my own risk and I hereby agree to abide by Buffalo River Shooting Club’s range officer’s instructions and range orders which range orders I confirm having read and which I declare to be fully binding on me.


As a member of the shooting club, please take note of the following:
• A Member is only allowed to take his dependants (spouse, children etc.) to the range as visitors. Special permission can be arranged by contacting the Committee in advance.
• A Member may not give his membership card to another person to use. This amount to fraud and the Club will prosecute the member responsible.
• If a member damages any property on the range, he is liable and the Club expect the member to act in a responsible manner.
• A Member must be sure about all the safety rules and regulations of the range.
• No shooting at glass and/or Wild Life on the range.
• A Member must produce his membership card and ID document on request. Failure to do so will result in the person being asked to leave the range.
• Physical and or Verbal abuse towards the caretaker is not allowed.
• Member must take note of the “Code of Conduct”.
• Period of Membership is a minimum of one year.

If a member contravenes any of the Club rules, he/she will be liable to disciplinary action.

If a member is unsure about any of the rules and or regulations, a copy of the Constitution is available on request.
Please Note! ~ Ignorance is no excuse!

I Agree   Date:
Name:   Id. Number:
Id: ID Photo: