Alaska Machine Gun Association

Name: _________________________________________________________________________________

Physical Address: ______________________________________________________________________

Mailing Address (if different): ___________________________________________________________

Telephone: Home_______________ Work ______________ Cell _____________ Fax _____________

E-mail (primary): ____________________________ (Secondary) ______________________________

I certify by my signature below that I am 21 years of age or older, and that no criminal or civil act has resulted in any disability that would preclude my purchase, possession, or use of a firearm under applicable Federal and State law.

The AMGA meets on a monthly basis (currently at the Pizzaman Restaurant in Eagle River, AK at 7:00 pm on the last Wednesday of each month) and conducts both competitive and informal shooting events throughout the year; guest(s) and non-members are welcome at both meetings and events as spectators, but the benefits applicable to shoots, discounted pricing on merchandise, participation in group ammunition orders, and any other benefits are limited to paid members.

Signature: ________________________________________________ Date _______________________

Membership credentials will be E-mailed to all electing to join after review by the AMGA Officials.

Authorized AMGA Official ________________________________________

Dues Paid (yes/no) __________________ Add to mailing list only (yes/no) __________________

Signature of the participant below certifies that the following statements are truthful in the affirmative and that there are no legal disabilities that would preclude the participant from being in possession, or the use of firearms within the State of Alaska.

I/We are not under indictment or information in any court for a felony, or any other crime, for which the Judge could impose imprisonment for more than one year.

I/We have not been convicted in any court of a felony, or any other crime, for which the Judge could have imposed imprisonment for more than one year, even if a shorter sentence was imposed including probation.

I/We are not a fugitive from justice.

I/We are not an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance.

I/We have never been adjudicated mentally defective (to include having been adjudicated incompetent to manage my/our affairs) or committed to a mental institution.

I/We have not been discharged from the armed forces under dishonorable conditions.

I/We am/are not subject to a court order restraining me/us from harassing, stalking, or threatening our child or an intimate partner or a child of such partner.

I/We have not been convicted in any court of a misdemeanor crime of domestic violence.

I/We have never renounced our United States citizenship.

I/We am/are not an alien illegally in the United States.

I/We certify that the identification we are providing is accurate and truthful.