NATIONAL SHOOTING SPORTS FOUNDATION, INC.
11 Mile Hill Road
s
Newtown, CT 06470-2359
s
Tel (203) 426-1320
s
Fax (203) 426-1087
s
nssf.org
Premium Range Membership Application
This NSSF® Premium Range Membership is an exclusive membership for businesses that include indoor or
outdoor shooting ranges. Membership constitutes agreement to and acceptance of all membership terms
and conditions included with application. This membership category is not intended for personal ranges.
Premium Range Members are not eligible to receive premium retail benefits unless they separately apply and
pay dues for Premium Retail Membership.
NSSF Member ID# (if applicable)_____________________
Company Name_____________________________________________________________________________
Physical Range Location Address ______________________________________________________________
City______________________________________________ State_______________ Zip________________
Phone______________________________________________________________________________________
Website_____________________________________________________________________________
Mailing Address
(if different from above)______________________________________________________________________
City______________________________________________ State_______________ Zip________________
Individual designated for liaison between the company and NSSF:
Name_______________________________ Title ___________________ E-mail_________________________
Secondary contacts:
Name_______________________________ Title ___________________ E-mail_________________________
Name_______________________________ Title ___________________ E-mail_________________________
Dues Structure
o Premium Membership................. $1,500­.00
If you have multiple store locations and would like premium
benefits for each one, separate applications must be filled
out for each store and dues are required for each individual
location.
3 Yes, I would like the Industry Reference Guide.
o
Member Price............................................ $95.00
Included in Premium Membership.
Please make check payable to NSSF or enter your
credit card information:
o MasterCard o Visa
o American Express o Discover
Card #________________________________________
Security code____________ Exp. Date______________
Signature______________________________________
Please print name_______________________________
Membership is non-refundable and no extensions will be granted for non-usage. The NSSF is a 501(c)(6) tax-exempt, non profit trade association, and, as
such, membership dues payments, contributions or gifts made to NSSF are not tax deductible as charitable contributions for federal income tax purposes.
However, membership dues may be tax deductible as ordinary and necessary business expenses to the extent allowed by law.
Next Page
NSSF is the trade association for America’s firearms industry.
Our mission: To promote, protect and preserve hunting and the shooting sports.
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Type of business (check one):
o Retail
o Retail/Range
o Individual/Sole Proprietorship
o Nonprofit Corporation
o Gunsmith
FFL#___________________________________
o Partnership/LLP
o Corporation
o Unincorporated Association
o LLC – Taxed as a Sole Proprietorship o LLC – Taxed as a Partnership
o LLC – Taxed as a Corporation
# of employees _____________________ Do you have access to any other coverage that may provide financial assistance similar to the NSSF Premium
Range Legal Defense Fund (e.g., insurance, group legal services plan, program or policy, other
funding sources)? o Yes o No
If yes, please provide sources of funding and amounts:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
PREMIUM RANGE MEMBER PRIMARY BENEFIT OPTIONS
Please select which primary benefit option your range would like to utilize through your premium membership:
Option A
o OSHA mock audit, access to financial assistance through the legal defense fund and access
to all additional services & benefits.
Please provide preferred dates for a compliance audit of your business by NSSF OSHA compliance consultant:
1)______________________________ 2)_______________________________ 3)__________________________
Option B
o Shooting Range Consultant Grant Program and access to all additional services & benefits.
Please describe what type of consulting service your range is looking for:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
OSHA HISTORY REPORT
Applicants utilizing Option A are required to accurately complete the OSHA history report section.
Incomplete reports may impact applicants’ eligibility to receive financial legal support should a future
citation arise.
Has your business been visited by OSHA or State OSH within the past six (6) months? o Yes
If yes, was your business issued any citation for OSHA violations? o Yes
o No
o No
If yes, please list the violations and the category level (other than serious, willful, etc.) for each based on
your settlement with OSHA or State OSH. Begin typing within the box on next page.
*
5/16 Item #4046
Legal Defense Fund: Legal defense fund services are subject to the following additional terms and conditions:
a. All decisions concerning the Legal Defense Fund, including, without limitation, eligibility, approval or denial of coverage, the
selection and engagement of legal defense counsel, and the amount paid to counsel, shall be made solely by NSSF, whose decisions
shall be final. NSSF shall have the exclusive right to terminate counsel at any time with or without cause.
b. Premium Range Members agree to cooperate fully with both NSSF and legal counsel chosen by NSSF. Services may be suspended
or terminated and the NSSF shall have the right to obtain reimbursement from a member for all legal defense costs paid in the
event of non-cooperation.
c. Premium Range Members must be existing members in good standing prior to any known administrative action or regulatory
legal proceeding for which legal defense funding assistance is requested, and must remain in good standing throughout the entire
duration of the administrative action or legal proceeding.
d. Premium Range Members to whom services are provided are entitled to the same rights and privileges, including the right of
confidentiality, to which any other client of an attorney is entitled. NSSF shall not require Legal Defense Fund attorneys to reveal
to any other persons any matters revealed to them in confidence by any member in the course of their representation without the
member’s permission.
e. The Legal Defense Fund does not cover fines or penalties that may be assessed against a range. Legal Defense Fund benefits are
provided on a secondary excess basis. No benefits shall be provided under the Legal Defense Fund to the extent benefits are
furnished to a member by any other plan, program, or policy that provides group legal services to the member or under a contract
of insurance.
f. The determination of NSSF shall be final and conclusive in connection with any dispute arising as to coverage or benefits derived
from the Legal Defense Fund.
g. NSSF is neither a law firm nor provides legal representation or legal services of any kind. Attorneys selected by NSSF are
independent contractors and NSSF shall have no liability in tort, contract or otherwise to Premium Range Members, legal defense
counsel or other interested party in connection with any assistance NSSF provides.
h. Premium Range Members agree to participate in periodic program surveys and other continuous improvement efforts.
CITATIONS/VIOLATIONS
Please list the violations and the category level (other than serious, willful, etc.) for each based on
your settlement with OSHA or State OSH. Begin typing within the box below.
Citations/Violations
Date(s)
Category Level
Continued on Next Page
NSSF is the trade association for America’s firearms industry.
Our mission: To promote, protect and preserve hunting and the shooting sports.
*
CITATIONS/VIOLATIONS
Citations/Violations
Date(s)
Category Level
PLEASE RETURN YOUR APPLICATION AND PAYMENT BY MAIL OR EMAIL TO:
NSSF, 11 Mile Hill Road, Newtown, CT 06470, Membership Department, [email protected].
Once you are a NSSF range member, please provide additional
information by logging on to wheretoshoot.org
NSSF is the trade association for America’s firearms industry.
Our mission: To promote, protect and preserve hunting and the shooting sports.
NATIONAL SHOOTING SPORTS FOUNDATION, INC.
PREMIUM RANGE MEMBERSHIP
1. Eligibility: Premium Range Membership is open to qualifying U.S. based indoor or outdoor shooting ranges meeting
the following eligibility requirements.
a. Applicants must have existing legally mandated and voluntary written workplace occupational safety and health
(OSH) programs for their place of business, or are in the process of developing them, and be in compliance
with all applicable federal, state and/or local safe work environment requirements (e.g., reporting, postings,
recordkeeping, etc.) at the time of application.
b. Applicants subject to any pending federal, state or local OSH administrative action (e.g., contest, notice, violation,
penalty or abatement), or civil or criminal OSH-related legal proceeding are ineligible to receive legal defense fund
assistance on pending issues. Ranges with prior OSH violations will only receive legal defense fund assistance on
violations they have not been cited on within 3 years of the date of application.
c. Applicants must pay applicable Premium Range Membership dues and assessments.
d. Applicants must agree to a free NSSF OSH compliance audit upon application and every two years thereafter.
Significant changes to range operations during the term of membership may require additional audits as
determined by NSSF.
Premium Range Membership is not a guarantee of legal defense funding coverage.
2. Membership Rights & Privileges: Premium Range Members shall have the rights and privileges extended to them
under the NSSF bylaws or, in the absence of an express bylaw provision, as may from time to time be granted to them
at the sole discretion of NSSF. Neither memberships nor membership rights are transferable. Some Premium Range
Membership benefits are provided by third parties. The NSSF makes no representations or warranties regarding third
parties or the continued availability of membership benefits. The NSSF shall not be responsible for any loss, damage
or dispute members may have with third parties, or the usefulness of any benefits or outcome of any services provided.
Members should make their own inquiries regarding the terms and conditions that apply to products or services offered
by third parties. Membership does not create any express or implied agency, attorney-client, broker/insurer-insured
or other relationship between NSSF and members, although information concerning member transactions with third
party product and service providers may be shared with NSSF. NSSF Premium Range Membership is not a prepaid legal
services, insurance or indemnification plan.
3. Legal Defense Fund: Legal Defense Fund services are subject to the following additional terms and conditions, which
may be amended, supplemented or repealed at any time:
a. All decisions concerning the Legal Defense Fund, including, without limitation, eligibility, approval or denial of
coverage, the selection and engagement of legal defense counsel, and the amount paid to counsel, shall be made
solely by NSSF, whose decisions shall be final. NSSF shall have the exclusive right to terminate counsel at any time
with or without cause.
b. Premium Range Members agree to cooperate fully with both NSSF and legal counsel chosen by NSSF. Services may
be suspended or terminated and the NSSF shall have the right to obtain reimbursement from a member for all
legal defense costs paid in the event of non-cooperation.
c. Premium Range Members must be existing members in good standing prior to any known administrative action
or regulatory legal proceeding for which legal defense funding assistance is requested, and must remain in good
standing throughout the entire duration of the administrative action or legal proceeding.
d. Premium Range Members to whom services are provided are entitled to the same rights and privileges, including
the right of confidentiality, to which any other client of an attorney is entitled. NSSF shall not require Legal Defense
Fund attorneys to reveal to any other persons any matters revealed to them in confidence by any member in the
course of their representation without the member’s permission.
e. The Legal Defense Fund does not cover fines or penalties that may be assessed against a range. Legal Defense Fund
benefits are provided on a secondary excess basis. No benefits shall be provided under the Legal Defense Fund
to the extent benefits are furnished to a member by any other plan, program, or policy that provides group legal
services to the member or under a contract of insurance.
Continued on Next Page
NSSF is the trade association for America’s firearms industry.
Our mission: To promote, protect and preserve hunting and the shooting sports.
*
f. The determination of NSSF shall be final and conclusive in connection with any dispute arising as to coverage or
benefits derived from the Legal Defense Fund.
g. NSSF is neither a law firm nor provides legal representation or legal services of any kind. Attorneys selected by
NSSF are independent contractors and NSSF shall have no liability in tort, contract or otherwise to Premium Range
Members, legal defense counsel or other interested party in connection with any assistance NSSF provides.
h. Premium Range Members agree to participate in periodic program surveys and other continuous improvement
efforts.
4. Term of Membership: Premium Range Membership is for one (1) year commencing on the date of NSSF’s approval of
an application. Memberships may be renewed for additional one (1) year terms upon full payment of membership dues
and assessments and, if necessary, free compliance audit of the member’s business.
5. Membership Dues: NSSF membership dues are established annually by the NSSF and may be adjusted from time to
time as needed to support the operations and mission of NSSF.
6. Conformance with Antitrust Laws: It is NSSF policy to require that all of its trade association activities be conducted
in compliance with U.S. federal and state antitrust laws. It is the responsibility of NSSF members to be aware of the types
of activities that are prohibited by antitrust laws in connection with their NSSF membership. NSSF’s Antitrust Policy
& Guidelines are available to all NSSF members upon request. If members have specific questions relating to antitrust
compliance in connection with their NSSF membership they should contact their own legal counsel.
7. Use of NSSF Trademarks: Members in good standing are granted the non-exclusive, non-transferable, royalty-free
license to use the National Shooting Sports Foundation® registered name and “Proud Member” logo to promote
their membership in the NSSF. Members agree that they will do nothing inconsistent that might harm NSSF or NSSF’s
ownership rights in its name and logo. Each member agrees to use NSSF’s name and logo only as prescribed by NSSF and
not to use the name and logo in any manner that expresses or implies, or could be construed to express or imply, that the
NSSF endorses or certifies a member’s products, services or opinions, a member’s compliance with federal, state and/or
local laws or regulations, or in any manner that misrepresents, or has the appearance of misrepresenting, the relationship
between a member and the NSSF other than as a member-trade association relationship. Members who fail to maintain
their NSSF membership must immediately discontinue any and all use of NSSF’s name and logo.
NSSF reserves the right to approve, deny, drop from membership, or not renew membership for non-compliance, revise,
supplement, suspend or terminate membership terms, including the rights and privileges of membership, or to terminate
the Premium Range Membership Program for any reason, at any time upon reasonable notice.
NSSF is the trade association for America’s firearms industry.
Our mission: To promote, protect and preserve hunting and the shooting sports.
NATIONAL SHOOTING SPORTS FOUNDATION
POLITICAL ACTION COMMITTEE
11 Mile Hill Road
s
Newtown, CT 06470-2359
s
Tel (203) 426-1320
NSSF Corporate Member Prior Approval Form
For Corporations and LLCs Acting as Corporations Only
The National Shooting Sports Foundation (NSSF) has formed the NSSF Political Action Committee (NSSF PAC),
a federal multicandidate political action committee, to enable NSSF to support pro-firearms and ammunition
industry, pro-Second Amendment and pro-sportsmen candidates for federal office. Federal law requires a trade
association PAC to obtain prior approval from its corporate members before it may solicit contributions from the
corporate member’s executive and administrative personnel, stockholders, and their families (collectively known as
the “restricted class”). The law defines “executive and administrative personnel” to mean salaried employees who
have policymaking, managerial, professional, or supervisory responsibilities (but not foremen or line supervisors).
Providing consent to the NSSF PAC does not limit or restrict your company’s PAC (if you have one) from soliciting
contributions from your own employees. Please note that a corporation can only give prior approval to one trade
association PAC each calendar year. If you provide consent, your company’s restricted class is free not to make any
contributions.
I, having authority to do so, do hereby consent and give permission to the NSSF PAC to solicit voluntary, personal
contributions from my company’s restricted class during the following calendar years:
Authorizing signature for 2017_____________________________________________
Authorizing signature for 2018_____________________________________________
Authorizing signature for 2019_____________________________________________
Authorizing signature for 2020_____________________________________________
Authorizing signature for 2021_____________________________________________
Please sign for each year you would like to grant permission
Please provide the list of your company’s restricted class upon submission of this consent (name, title, mailing address, email
address and phone number).
Name:_____________________________________________ Title:__________________________________________
Print Name
Company Name:_____________________________________________________________________________________
Address:_____________________________________________________________________________________________
Telephone:________________________________________ Fax:___________________________________________
Email:_____________________________________________Date:____________________________________________
Please see next page.
NSSF PAC
List of Corporate Member’s
Restricted Class
Company: ___________________________________
Name:___________________________________ Title:__________________________________
Mailing Address:__________________________________________________________________
Email:___________________________________ Phone Number:_________________________
Name:___________________________________ Title:__________________________________
Mailing Address:__________________________________________________________________
Email:___________________________________ Phone Number:_________________________
Name:___________________________________ Title:__________________________________
Mailing Address:__________________________________________________________________
Email:___________________________________ Phone Number:_________________________
Name:___________________________________ Title:__________________________________
Mailing Address:__________________________________________________________________
Email:___________________________________ Phone Number:_________________________
Name:___________________________________ Title:__________________________________
Mailing Address:__________________________________________________________________
Email:___________________________________ Phone Number:_________________________
Please copy this page for additional executive and administrative personnel.
NSSF® Member Benefits
MEMBER TYPE
MEMBER SERVICE
5 Extra Booth Points
Guaranteed Press Room Bin At The SHOT Show (1)
SHOT Show® Booth Space Discount
SHOT Show Business Center
SHOT Show Directories - Free
SHOT Show Directories - Discount
SHOT Show Member Lounge
SHOT Show Attendee Free/Discount Ticket
SHOT Show UniversitySM Ticket - Free
State Of The Industry Pre-Sale Tickets
ASSOCIATE NON-PROFIT
RETAILER
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Compliance Audit - Free
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Compliance Packet
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Congressional Fly-In
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Employee Family Scholarship
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Five Star Rating Program
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Legal Defense
Literature Discount
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Media Consultant
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Member List (once a year use)
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Members Only Shopping Cart
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NSSF Import/Export Committee
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OSHA Audit - Free
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OSHA/State OSHA Compliance Program Review
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Range Action Specialist Consulting Program Discount
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Range Compliance Hotline - Free
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Research Discount
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Retailer Education Seminar Registration - Free
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Retailer Hotline - Free
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Research - Free
RANGE
MEDIA
INDIVIDUAL
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Compliance Audit Discount
Industry Job Postings Discount
PREMIUM
RANGE
SUPPORTING
ATF Action Alerts
ATF Industry Meetings
PREMIUM
RETAILER
VOTING
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upon request
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Air Filter Discount
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Credit Card Processing Discount
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Customized Website Design
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Display Case Discount
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Employee Background Check Discount
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E-Commerce Provider
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FedEx® Discount
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Firearms Industry Health Advantage
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Industry Networking Opportunities
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Key Control Solution Discount
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Point-Of-Sale Software Discount
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Property Casualty Insurance
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Range Ventilation System Discount
Security Closure Products Discount
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Security System Discount
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Security Window Film Discount
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Staples® Discount
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Video Surveillance Discount
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12/16
NSSF.ORG