Newport Rifle Club
PO Box 4366
Middletown, RI 02842


To the Applicant:  You must fill in this form in its entirety, and 
attend two consecutive regular meetings to complete the application 
process.  You will be introduced and your application announced at the 
first meeting.  The Executive Committee will act on it at their next 
meeting.  If approved, you will be accepted at the second meeting.  If 
you are not currently a member of the National Rifle Association (NRA) 
you may join through the club.  Membership in NRA is required.  At the 
second meeting you are expected to pay all fees and dues, $225.00 
($200.00 if you are an NRA member).  New member orientation is normally 
the Friday after the monthly meeting.  Transient military personnel 
provide one (1) copy of your current orders.  Your dues are $20.00 per 
month.


Last name                                              First Name        



Address:
number and street              city              state           zip



Telephone number           Date of Birth         email






Recommended by: ________________________________________


I hereby authorize Newport Rifle Club to investigate my background for 
any criminal record via any law enforcement agency and authorize access 
to all pertinent records.



Signature:____________________________________________


Sworn and subscribed before me in Middletown, RI on 



the _______ day of ________________, ___________ A.D.


Notary Seal:



Rhode Island residents:  Do you have a Pistol Permit issued by the 
Attorney General or local licensing authority?



Massachusetts residents:  Do you have a Mass License to Carry Firearms?



All Applicants:

a. Are you under indictment or information in any court for a 
   felony, or other crime, for which the judge could imprison you for more 
   than one year?



b. Have you been convicted in any court of a felony, or any other 
   crime, for which the judge could imprison you for more than one year, 
   even if you received a shorter sentence?



c. Are you a fugitive from justice?



d. Are you an unlawful user of, or addicted to, marijuana, or any 
   depressant, stimulant, narcotic drug, or any other controlled substance?



e. Have you been adjudicated mentally defective or have you ever 
   been committed to a mental institution?



f. Have you ever been discharged from the Armed Forces of the 
   United States under dishonorable conditions?



g. Are you subject to a court order restraining you from 
   harassing, stalking, or threatening your child or an intimate partner or 
   child of such partner?



h. Have you ever been convicted of a misdemeanor crime of domestic 
   violence?



i. Have you ever renounced your U. S. citizenship?



j. Are you an alien illegally in the United States?



k. Are you a non-immigrant alien?



l. If you are a nonimmigrant alien, are you authorized to possess 
   firearms in the United States?