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To the Antique and Historical Arms Collectors Guild of
Victoria, Inc (the “Guild”)
PO Box 2976, Cheltenham, 3192, Vic.
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I. the undersigned, a current member of the Guild, hereby request that I be included in the Guild's application for a display permit for the display at the club meetings set out in the permit to be held at Eley Park Blackburn of the firearms which I hold under my current category 1 and/or Category 2 collectors licence(s) listed below. I agree to comply with the terms of the permit from time to time applicable, including, but not limited to, expiry date and display and storage etc., conditions.
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Name in Full (print please) ....................................................................................................................................
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Address (for correspondence) in full ................................................................................
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Phone number..............................................
Number(s) of my Collectors Licences:
Category 1 ........................................
Category 2 ........................................
I agree to notify the Club immediately if any of the above details change.
(Signed)........................................................
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