National Small-bore Rifle Association
Youth Proficiency Scheme
Tutor Training Diploma Course
Dates of course …2nd and 3rd August 2014
Venue Beaudesert Park Campsite Cannock Wood
Rugeley Staffordshire WS15 4JJ
Registration through South West Cheshire Scouts
Full name (Include all forenames please):
Name as you would like it printed on your Tutor's Diploma if different:
Date of birth
Phone number
Email address
If under 18 a Tutor Trainer Diploma can
not be issued. However an attendance
certificate can. Please call to discuss any
persons under 18 who are being
considered for this course and ensure a
permission to shoot form is enclosed
Postal address:
Postcode:
Summary of Shooting Experience, Club membership & FAC details as appropriate:
I apply to undertake the National Small-bore Rifle Association Youth Proficiency Scheme
Tutor’s Diploma Course. I intend to use this qualification for charitable purposes.
I declare that I am not prohibited from possessing a firearm or ammunition by virtue of
section 21 of the Firearms Act 1968 (which applies to persons who have served a term of
imprisonment or youth custody).
I understand that the information on this form will be held by the NSRA in connection with
my registration as a YPS Tutor.
I enclose my payment of the course fee of £80.00 payable to The Beaudesert Trust
Signed ………………………………………………..
Return this form to:
01543 682278
rikkichamberlain@beaudesert.org
Date …………………….
Rikki Chamberlain
Beaudesert Park Campsite
Cannock Wood
Rugeley
Staffordshire
WS15 4JJ