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A PERSONAL HISTORY

1. Have you ever been or are currently a member of another gun club?  Y or N
   Please give name of club if applicable.________________________________
2. Have you even been refused or denied a Firearms Acquisition Certificate, or PAL, ATT, Firearms Registration Certificate, Restricted Weapons Registration or permits?  Y or N
3. Have you had a Firearms Acquisition Certificate or PAL, ATT, Firearms Registration certificate, Restricted Weapons Registration or permits revoked or seized? Y or N
4. Have you ever been convicted or discharged (including absolute or conditional discharge) involving the use, carriage, possession, handling or storage of any firearms or ammunition? Y or N

If you have answered yes to any of the above questions, please give specific details making reference to the particular question.

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