BOULDER RIFLE AND PISTOL CLUB
Boulder City, NV.

Post Office Box 60534
Boulder City, NV. 89006-0534
Chartered 1933
NRA, NSRPA and CMP Affiliated
Name  
Address  
City/State/Zip  
Phone [Home, Work]  
E-mail Address  
Occupation
  Date of Birth         /         /
Are you a Member of?
N.R.A.?    # NSRPA?    #
Interests:
(____) High Power Rifle (____) 3 Gun Matches
(____) Cowboy Action (____) ICORE (Revolver)
(____) Vintage Rifle Silhouette (____) Other:_____________________________

Annual Dues: $75.00 ( January 1 - December 31 ), Renewable each January 1.
Initiation Fee: $50.00 (First year only.)
Year Paid: (  ) 2008 (  ) 2009 (  ) 2010 (  ) 2011 (  ) 2012(  ) 2013 (  ) 2014 (  ) 2015 (  ) 2016
The required Range Safety/Orientation must be completed before the club membership card is issued to new members. Contact Range Safety Officers on the range or the Club Office for the next available session.

Pledge

I certify that I am a legal resident of the U.S., I am 18 years of age or older and I am not a member of any organization that has as any part of it’s program the attempt to overthrow the government of the United States by force or violence. I will fulfill the obligations of good sportsmanship and good citizenship.

Signed __________________________________ Date ____/____/____

For registration print form, mail with Check Payable to:
Boulder Rifle and Pistol Club
PO Box 60534
Boulder City, NV. 89006-0534

Waiver of Liability

I, __________________________________, do agree to hold harmless the Boulder Rifle and Pistol Club, Inc., it's officers, it's members and associates and the City of Boulder City, Nevada from any liability resulting from:

Any injury or damage arising from or incidental to my participation in any activity or class sponsored by the Boulder Rifle and Pistol Club, Inc.
Any injury or damage arising from or incidental to my travel to or from Boulder Rifle and Pistol Club, Inc. ranges, or any location at which the Boulder Rifle and Pistol Club, Inc. is conducting any activity.
Any injury or damage arising from or incidental to the actions of any person participating in any activity or class sponsored by the Boulder Rifle and Pistol Club, Inc.
Any injury or damage arising from or incidental to my actions of any sort while on the property of the Boulder Rifle and Pistol Club, Inc. during any time when Boulder Rifle and Pistol Club, Inc. is not conducting an activity.
Any injury or damage arising from or incidental to the actions of any member, officer, or associate of the Boulder Rifle and Pistol Club, Inc. while on the property of Boulder Rifle and Pistol Club, Inc. during any time when Boulder Rifle and Pistol Club, Inc. is not conducting an activity.
Any injury or damage arising from or incidental to the actions of any third party, while on the property of Boulder Rifle and Pistol Club, Inc. sponsors or conducts any activity or class.

Membership card will not be mailed until applicant has completed a range orientation class, which is held the 1st Saturday of each month at 0900 hrs at the Silhouette Range cover.

Signature __________________________________ Date ____/____/____

Witness ___________________________________

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