Safety Violation Report

You can use this form to report a suspected safety violation at the Club. When completed, the form will email a copy to the Executive, who will then review the report and act on appropriately. To be considered valid, we require your name, email address, a voice contact number and a brief description of the alleged event or incident. Please be as descriptive as possible.

Your Name (required)
Your Email (required)
Contact information should additional follow up or clarification be required:
Evening Phone:
Cell Phone:
Date of incident:
Time of incident:
Description of the alleged event or incident.

You agree to abide by the rule and regulations of the Burlington Rifle and Revolver Club. Please check this box to continue.

When you press send, a copy of the form will be emailed to our Executive for their review. You will also be sent a carbon copy and then you should be redirected back to the main page. If you are not redirected back to the home page, it could be a browser or javascript setting on your end. Do not keep pressing the send button. Please make sure that your email program will accept email from * Please check remember to check your SPAM folder if you do not get a copy to confirm receipt of your application. Due to server load, this can take up to 30 minutes.