Dynasty ArmsMEMBERSHIP APPLICATIONRevised August 2021 Name * First Name Last Name Phone * (###) ### #### Email * Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country 1. Copy of Driver’s License (or state recognized picture ID card) * I have emailed a photo of my I.D. to dynastyarms@gmail.com 2. Have you completed any fire arms safety courses? * EXAMPLES ARE: NRA Basic Firearms safety Course, State Hunters Safety Program, Concealed Weapon or Firearm Carry License, NRA and/or NROI Range Officer Certification, NRA Certified Firearm Instructor, State of Florida Police Standards Certification, retired law enforcement, Active Military, or Honorable Military Discharge. Yes No 3. Are you a member of the NRA, NAAGA or any national or regional gun organization? * Yes No 4. Pay Membership fee * I have paid membership fee by cash to DA member. (Select member name below) I have paid membership fee online Dynasty Arms Members: If you paid membership fee by cash, please select the member who accepted your payment. Select Member Name Alex Byrd William Crusoe Kenny Johnson Susan Phillips I certify that I am not a member of any organization or group which has any part of its programs the attempted overthrow of the Government of the United States or any of its political subdivisions by force or violence and that I have never been convicted of a felony or crime or misdemeanor crime of domestic violence, nor am subject to a restraining order and have not be adjudicated mentally defective, nor have I been dishonorably discharged from the US Armed Force. I do not represent in any manner, or have financial agreements with any one or any organization who is or may be attempting to take any action against the Club which would affect its existence or continued operations. If admitted to membership, I will faithfully endeavor to fulfill the obligations of good sportsmanship and good citizenship, abide by all Club rules and assist in any way possible in the maintenance of the Club’s facility and furtherance of its objectives. I understand that failure to abide by the Club rules may result in termination of membership. I also understand that I may be subject to a Background Check. * Please type your signature below: By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. * Choose I Accept I do not accept Thank you for your application. Please remember to email your photo ID to dynastyarms@gmail.com, and submit you $25 membership fee at dynastyarmsinc.com/membership