*** Please complete this form and then click the “PROCEED” button at the bottom to pay with credit card. ***

credit cards accepted
You must be a citizen of the United States at least 18 years of age and legally disabled on the date you apply.

KERN RIVER VALLEY GUN ASSOCIATION
PO Box 958
Wofford Heights, CA 93285
www.krvga.org
*Operating on a non-discriminatory basis with a special use permit from the U.S. Forest Service*
You must be a citizen of the United States and at least 18 years of age on the date you apply.

LEGALLY DISABLED LIFETIME MEMBERSHIP APPLICATION

There is a one-time fee of $220.00 for Legally Disabled Lifetime Members. Documented proof of legal disability may be required. Please fill out the form below. Fields marked 'required' must be filled out. You will enter your credit card information after clicking the 'Proceed' button at the bottom of the form.






Are you a member of: The National Rifle Association (NRA)? NOYES - Number
Are you a member of: California Rifle and Pistol Association (CRPA)? NOYES

To help defend our 2nd amendment rights, the KRVGA encourages its members to join the NRA and CRPA.

PLEDGE

I CERTIFY THAT I AM A CITIZEN OF THE UNITED STATES, THAT I AM NOT A MEMBER OF ANY ORGANIZATION WHICH HAS ANY PART OF ITS PROGRAM THAT ATTEMPTS TO OVERTHROW OUR GOVERNMENT OF THE UNITED STATES BY FORCE OR VIOLENCE; THAT I HAVE NEVER BEEN CONVICTED IN ANY COURT OF A CRIME PUNISHABLE BY IMPRISONMENT FOR A TERM EXCEEDING ONE YEAR; THAT I AM NOT AN ALCOHOLIC OR ILLICIT DRUG USER; AND THAT, IF I AM ADMITTED TO MEMBERSHIP, I WILL FULFILL THE OBLIGATION OF GOOD SPORTSMANSHIP AND GOOD CITIZENSHIP, AND OBEY ALL CLUB RULES.

Select date of acceptance:

(The above box must be checked to accept the pledge, it will represent your signature)

Continue by thoroughly reading the following:

RELEASE AND INDEMNIFICATION AGREEMENT

IN CONSIDERATION of my being given permission to observe and/or participate in the shooting, sporting and outdoor activities at the Kern River Valley Gun Association, I agree to thoroughly read and enter into this release and indemnification agreement by checking the agreement box at the end.

I am entering into this agreement freely, voluntarily, and specifically state that:

1. I am not dazed, suffering from shock or under the influence of drugs or alcohol;
2. I understand that this is a full and complete release and indemnification agreement; and
3. There has been no fraud or other conduct used in obtaining my signature and agreement to this document.

I will comply with all rules and regulations. If I have questions, or observe any unusual or unnecessary hazard during my participation, I will immediately bring such to the attention of the nearest official, and I have read all range rules and will comply with completely.

I understand that the observation and/or participation in the shooting, sporting and outdoor activities will expose me to certain risks inherent to the use of firearms and related activities. These include, but are not limited to, personal or bodily injury, death and/or property damage.

I agree to assume and accept the dangers inherent in the observation and/or participation of the shooting, sporting and outdoor activities.

I represent that I have no drug, health or mental problem that could or will interfere with my observation and/or participation of the shooting, sporting and outdoor activities.

I agree that I am responsible for my own safety and the safety of any guest or child that I may bring to the premises of the Kern River Valley Gun Association.

I agree that the Kern River Valley Gun Association, its members, officers, directors, employees, agents, representatives, affiliates, subsidiaries, successors or assignees and all participating groups and persons officially connected with the activities, including but not limited to the Kern River Valley Gun Association, will not be liable if I, my guest or child suffer any personal or bodily injury, death or property damage as a result of ordinary negligence.

I further agree that in the event that the Kern River Valley Gun Association, its members, officers, directors, employees, agents, representatives, affiliates, subsidiaries, successors or assignees and all participating groups and persons officially connected with the activities, including but not limited to the Kern River Valley Gun Association, and become liable by way of contribution, indemnification, judgment, verdict, award or otherwise, to any other party as a result of my actions, negligence or injury, I agree to indemnify and hold harmless the Kern River Valley Gun Association, its members, officers, directors, employees, agents, representatives, affiliates, subsidiaries, successors or assignees and all participating groups and persons officially connected with the activities, including but not limited to the Kern River Valley Gun Association, from any and all claims, demands, actual legal costs or other costs or expenses arising out of said actions, negligence, or injury, no matter who might bring said claim, if any be brought.

Select date of acceptance:
I HAVE READ THE FORGOING RELEASE AND INDEMNIFICATION AGREEMENT, AND

(The above box must be checked to accept the RELEASE AND INDEMNIFICATION AGREEMENT, it will represent your signature)
CAUTION! READ BEFORE CHECKING BOX.


Clicking the 'Proceed' will take you yo the payment screen ($225.00)

*Operating on a non-discriminatory basis with a special use permit from the U.S. Forest Service*