MAIL THIS: O COMPLETED FORM(S), O YOUR PAYMENT, O SELF ...

File: LRPC2018RenewalandNewMemberForm-1

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Office Use Only -- Mark out (X) as task is completed

LEROY RIFLE AND PISTOL CLUB --- 2018 --- RENEWAL & NEW MEMBER FORM

MAIL THIS: O COMPLETED FORM(S), O YOUR PAYMENT, O SELF ADDRESSED & STAMPED RETURN ENVELOPE, O A COPY OF YOUR NRA MEMBERSHIP CARD OR THE LABEL FROM YOUR NRA MAGAZINE, (with your member number and expiration date on it) O A COPY OF YOUR FOID CARD.

Send all of the above to: LRPC, PO Box 142, LeRoy, IL 61752. 2018 dues are payable NOW! Date of Application: ______________________ Name __________________________________________AGE_______ D.O.B. ___________________ Address________________________________ City __________________________Zip_____________ Home Phone (___) __________________________ Cell Phone (___) ___________________________ Occupation ? if retired, prior to retirement______________________________________ E-mail address ____________________________@______________________________ The newsletter is available on our website at To accommodate those without internet the newsletter will be sent via the U S Postal Service upon request to editor@

Are you able to help with work at the range? ______ If not please state a reason below.

You must show proof of your NRA membership and your FOID card ? See note at the top of the page.

Membership number for the NRA_________________________ Expiration Date ______________________ My FOID card number is: _______________________________ Expiration Date ______________________

I certify that I am now (check one): ( ) A Primary Range Member ( ) A Range-Spouse - file forms only-no fee. ( ) A Primary General Member ( ) A New Applicant ? also be sure to obtain, sign, and enclose all waivers!

By accepting membership into the Leroy Rifle and Pistol Club I hereby grant the Leroy Rifle and Pistol Club, the National Muzzle Loading Rifle Association and the National Rifle Association the right and permission to copyright and or use, reuse, publish and or republish photographic images or pictures of me during scheduled events for promotional or advertising. I hereby release, discharge and hold harmless the Leroy Rifle and Pistol Club, the National Muzzle Loading Rifle Association and the National Rifle Association from any liability resulting from use of the above mentioned photography or the use of minor's name. I understand that I will have no control over the manner of use of the materials produced and hereby waive any right to pre-approve or inspect materials prior to distribution.

The above information is true and correct to the best of my knowledge.

Signature of applicant ___________________________________________________

New applicants: Please include $180.00 check with these forms to begin processing.

1-year Family Membership dues for 2018?for all new or renewing Primary members $150.00 __________

NOTE: Member's spouse, and offspring under 21, may attend training classes and use the range when accompanied by the Primary Family Range Member with no limits or charges. Offspring over 21 need their own individual primary memberships.

Training and Processing--a one-time fee for Range user's qualification classes Date Paid: __________ Total Paid $__________ Check # ___________

$30.00 ___________

NOTE: Member's spouse, who wants to use the range without the family Primary Member present, needs to file a separate application--sign all waiver forms-- possess and show NRA and FOID cards--pay the one-time $30 fee, & finish training classes. Spouse will then receive an all-access Range-Spouse membership card.

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MEMBER RANGE RELEASE AND WAIVER LEROY RIFLE AND PISTOL CLUB

This release, waiver, and indemnity agreement, hereinafter referred to as release, is executed on the date shown below by the range member who is hereinafter referred to as the RELEASOR.

In consideration of being permitted to use firearms at LRPC ? Range or to participate in events at LRPC ? Range, the RELEASOR and the RELEASOR'S personal representative and next of kin releases, waives, discharges and covenants not to sue the LRPC, its officers, members and guests, event sponsors, volunteers, or employees, hereinafter referred to as RELEASEES, for all liability to the RELEASOR including the RELEASOR'S personal representatives, assigns, heirs and next of kin for all loss or damage, and any claim or damage therefore, on account of injury to the person or property or resulting in death of the RELEASOR, whether caused by the negligence of the RELEASEES or otherwise while the RELEASOR is using the grounds for any purpose at any time, whether shooting, volunteering, or engaged in any activity at the LRPC ? Range, hereinafter referred to as Range.

RELEASOR assumes full responsibility for risk of bodily injury, death or property damage due to the negligence of RELEASEES or otherwise while at the Range or while competing, officiating in, volunteering for any purpose or participating in shooting or any other activity at any time at the Range.

RELEASOR, being of lawful age, in consideration of being permitted to participate in shooting activities, does for himself or herself, his or her heirs, executors, administrators and assigns, hereby release and forever discharge the RELEASEES from any and every claim, demand, action or right of action, of whatsoever kind or nature, either in law or in equity arising from or by reason of any bodily injury or personal injuries known or unknown, death and/or property damage resulting from or to result from any accident which may occur at any time as a result of participation in shooting activities or any other activities in connection with the use of the Range, whether by negligence or not.

RELEASOR further releases the RELEASEES from any claim whatsoever on account of first aid, medical treatment or service rendered to the RELEASOR during the participation in any activities at any time at the Range.

RELEASOR agrees to hold harmless and indemnify, including the payment of legal fees and court costs, the RELEASEES and each of them from any loss, liability, damage or cost RELEASEES may incur due to the presence of RELEASOR in the LRPC ? Range whether caused by negligence of the RELEASEES or otherwise.

RELEASOR agrees that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of Illinois, and if any portion of the agreement is held invalid, it is agreed that the balance will, notwithstanding, continue in full legal force and effect. In the event there is any dispute regarding the validity of this agreement or the RELEASOR has any claim or cause of action against the RELEASEES, it is agreed between the parties that the venue shall be held in the 11th Judicial Circuit Court House located in McLean County, Illinois.

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RELEASOR further states (1) that he or she has carefully read the above release and knows the contents of the release, and signs this release as his or her own free and voluntary act, and (2) that RELEASOR is legally authorized to possess and use firearms in the State of Illinois. This release shall remain in effect indefinitely. This release contains the entire agreement between the parties to this agreement and the terms of this release are contractual and not a mere recital. Releasor (Member) Signature ____________________________ Date _______________

Printed Name ____________________________________

Witness Signature _____________________________________ Date _______________ Printed Name ____________________________________ Title ____________________

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