Contact Us Ryan Secretary 0473140953 Adam Captain Jamie Vice Captain 0498620143 Name Email Address Have you been refused or prohibited from holding a firearms licence or permit or had a firearms licence or permit suspended, cancelled or revoked? Have you been refused or prohibited from holding a firearms licence or permit or had a firearms licence or permit suspended, cancelled or revoked?YesNo Have you been the subject of a Firearms Prohibition Order? Have you been the subject of a Firearms Prohibition Order? YesNo With the last 10 years been convicted of an offence involving firearms, weapons, drugs, robbery, violence, terrorism or an offence of a sexual nature? With the last 10 years been convicted of an offence involving firearms, weapons, drugs, robbery, violence, terrorism or an offence of a sexual nature?YesNo Within the last 10 years been the subject of a Family Law Order or Final Domestic Violence Order or a Final Apprehended Violence Order (other than an order that was revoked)? Within the last 10 years been the subject of a Family Law Order or Final Domestic Violence Order or a Final Apprehended Violence Order (other than an order that was revoked)?YesNo Have you ever attempted suicide or self harm? Have you ever attempted suicide or self harm?YesNo In the past 12 months been treated or referred for treatment for alcoholism, drug dependence or a mental illness withing the meaning of the Mental Health Act 2007 or as a mentally disordered person withing the meaning of the Act? In the past 12 months been treated or referred for treatment for alcoholism, drug dependence or a mental illness withing the meaning of the Mental Health Act 2007 or as a mentally disordered person withing the meaning of the Act?YesNo Are you currently subject to a Good Behaviour Bond? Including a community correction order or a conditional release order? Are you currently subject to a Good Behaviour Bond? Including a community correction order or a conditional release order?YesNo Are you currently subject to an Interim Apprehended Violence Order? Are you currently subject to an Interim Apprehended Violence Order?YesNo Are you currently suffering from any mental illness or other disorder that may prevent you from using a firearm safely? Are you currently suffering from any mental illness or other disorder that may prevent you from using a firearm safely?YesNo Message 5 + 11 = Submit Shoalhaven Pistol Club, Shoalhaven NSW, Australia