First Name: (*) Middle Name: Last Name: (*) In signing this application, I certify that I am a citizen or am legally authorized to keep and bear arms under the United States Constitution, and I am not in any manner prohibited from owning or using firearms under any Federal, State, or Local law or order of any Court of competent jurisdiction. I testify that I am not an illegal alien or unlawfully in the United States. I agree to abide by the Rules and Regulations as may from time-to-time be promulgated or modified by Southern Tactical Range, LLC for conduct at the Range. The Membership Level for which I am applying is: (choose one) ---Shotgun PackageBasic PackageHunter PackageTactical PackageSniper Package Once accepted for membership, Membership Renewal is ANNUAL and is NOT AUTOMATIC. Members have a two week grace period to renew their membership each year. Southern Tactical Range, LLC will send out a renewal invoice one month prior to the expiration of the membership each year. The Membership fees MUST be paid on time or in advance as Memberships will expire with no guarantee of being added to the capped membership pool. In addition, membership fees may increase over time as reflected in your renewal invoice. Southern Tactical Range LLC also reserves the right to revoke membership for unsafe, disruptive, or disobedient behavior without a refund. If an applicant is not qualified to use a particular range, or does not possess the required rifle system, Southern Tactical Range LLC has instructional courses available to help a member become certified to use this range under supervision. Any member who damages Southern Tactical Range, LLC property as a result of failure to adhere to all Rules and Regulations shall be responsible for any and all damages resulting therefrom, including consequential damages; by way of example only, members who damage steel by shooting steel core, armor piercing, rifle ammunition, shotgun slugs or any other type of prohibited ammunition that causes damage to these targets, will be charged the full value of that steel plus any shipping costs incurred. PRIMARY MEMBER INFORMATION: Address: (*) City: (*) State: (*) Zip: (*) Phone Number: (*) Business Number: Cell Number: Email: (*) Birth Date: (*) Occupation: Employer: Employers Address: NRA#: Expiration Date: US Military Active Duty or Veteran? YesNo Branch of Service: Law Enforcement or Former Law Enforcement? YesNo Organization Name: Overall Shooting Experience: (1 = Novice, 5 = Expert) ---12345 Other pertinent data for membership the applicant may wish to present: List Any Serious Medical Conditions: EMERGENCY CONTACT INFORMATION: Emergency Contact: (*) Relationship: (*) Contact Phone Number: (*) Emergency Contact Email: The following questions must be answered before any action can be taken on your application for membership: 1. Are you now eligible to purchase a firearm under State and Federal Law? YesNo 2. Are you now, or have you ever been, any of the following: A. An unlawful user of or habitually addicted to any controlled substance to include alcohol? YesNo B. Been adjudicated as a mental defective or been involuntarily committed to a mental institution? YesNo C. Been subject to proceedings under the “Baker Act” in the State of Florida or similar proceedings in any other jurisdiction? YesNo D. Been dishonorably discharged from Military Duty related to mental health? YesNo APPLICANT SIGNATURE: (hold the left mouse button or use a touchscreen to sign) ADDITIONAL INSTRUCTIONS & CONDITIONS: 1. For alternative submission methods, email us at Southerntacticalrange@gmail.com or call. Additional Terms: 2. Initial Individual Membership Dues WILL BE CHARGED at the time a member receives their ID badge. ID Badges must be picked up within 10 days of notice that membership has been awarded. 3. Driver’s License photo copy must be submitted to STR when ID badge issued on site. 4. For minors, birth certificate copy will be necessary. Legal Guardians must also sign Minor Waiver. 5. All membership fees are final upon ID badge being issued. 6. STR LLC reserves the right to revoke membership for unsafe and/or disorderly conduct without refund at its SOLE DISCRETION. [recaptcha] By checking this box, you are confirming that you have read and understand the Range Rules and Policies.