Membership Renewal Form

Online application

Please fill in this form by November 30, 2022. A copy will be sent to your email, please check your spam/junk mail.

Payment may be cheque or money order mailed with this form or e-transfer to

"*" indicates required fields

Firearms Licence Expiry Date*
** Members are responsible for ensuring their CSSA membership is valid when attending HCMC**
CSSA Expiry Date*
Expiry date is just month and year, so put in any date for day.
Provide details of any new (as of 2022) shooting certifications (Range Safety Officer, Holster Certification, etc.) below:
Click on the + sign to add in another qualification.
Date Qualified (mm/dd/yyyy)
Club or Certifying Association:
Drop files here or
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 3 MB, Max. files: 3.
    Renewal Fees*
    *Family Membership: Member + Spouse + Children seventeen years of age or younger and children living at home and in attendance at school under the age of 21. Family members who are regular, active shooters should fill out separate renewal forms and attach them to the main membership renewal.
    †Junior Membership: Member who has not reached his/her 18th birthday.
    I acknowledge that I have read and fully understand the accompanying document that outlines the responsibility of the Member, herein described, to act as a Range Safety Officer as required on Haliburton County Marksmen Club Inc. property.*
    Please check this box giving your permission to be included in Haliburton County Marksmen Club Inc. emails for bulletins and information.
    Applicant's Agreement*
    By ticking this box, I acknowledge that I have read, and agree to abide by, Haliburton County Marksmen Club Inc. by-laws, rules, range safety basics and related guidelines as displayed on the website, posted at the Club, or otherwise made available. I understand that non-compliance may result in Club discipline that may include suspension of membership and/or range access.
    Agreement Date*

    PDF Application with Fillable form

    This form can be filled out and digitally signed using Adobe Acrobat Reader.

    Please fill in this document, print it, sign it, and mail it to:
    Haliburton County Marksmen Club Inc., P.O. Box 56, Kinmount, ON K0M 2A0 by November 30, 2021.
    Payment may be cheque or money order mailed with this form or e-transfer to