NATIONAL SHOOTING SPORTS FOUNDATION, INC.

Transcription

1 NATIONAL SHOOTING SPORTS FOUNDATION, INC. 11 Mile Hill Road s Newtown, CT s Tel (203) s Fax (203) 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. 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 Fax Website Mailing Address (if different from above) City State Zip Individual designated for liaison between the company and NSSF: Name Title Secondary contacts: Name Title Name Title Dues Structure o Premium Membership... $1, 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. o 3 Yes, I would like the Industry Reference Guide. 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. Next Page *

2 Type of business (check one): o Retail o Retail/Range o Gunsmith o Individual/Sole Proprietorship o Partnership/LLP o Corporation o Nonprofit Corporation o Unincorporated Association o LLC Taxed as a Sole Proprietorship o LLC Taxed as a Partnership o LLC Taxed as a Corporation 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: OSHA HISTORY REPORT FFL# Applicants are required to accurately complete the OSHA history report section. Incomplete reports may impact applicants elegibility to receive financial legal support should a future citation arise. Please provide preferred dates for a compliance audit of your business by NSSF OSHA compliance consultant. 1) 2) 3) Has your business been visited by OSHA or State OSH within the past six (6) months? o Yes o No If yes, was your business issued any citation for OSHA violations? o Yes 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 the next page. 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. 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. * 10/15 Item #4046

3 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 Please return your application and payment by mail or to: NSSF, 11 Mile Hill Road, Newtown, CT 06470, attn: Ann Siladi, Once you are a NSSF range member, please provide additional information by logging on to wheretoshoot.org

4 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. 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 *

5 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.

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7 NATIONAL SHOOTING SPORTS FOUNDATION POLITICAL ACTION COMMITTEE 11 Mile Hill Road s Newtown, CT s Tel (203) 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 2015 Authorizing signature for 2016 Authorizing signature for 2017 Authorizing signature for 2018 Authorizing signature for 2019 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, address and phone number). Name: Print Name Title: Company Name: Address: Telephone: Fax: Date: Please see next page.

8 NSSF PAC List of Corporate Member s Restricted Class Company: Please copy this page for additional executive and administrative personnel.