ANTRIM SAND PIT SHOOTERS REGISTRATION FORM

 NAME:__________________________________________________   PLEASE PRINT

 EMAIL:__________________________________________________

 DIVISION:______CLASS:______Power Factor: Major ____ Minor____

 USPSA NUMBER:____________________AMOUNT PAID:__________

PHONE NUMBER:________________________

PARTICIPATION RELEASE AND AGREEMENT

In consideration of permission to participate in the shooting contest held at the Chain O’Lakes Sportsman’s Club on the dates listed below, I do hereby release the United States Practical Shooting Association/IPSC, a non-profit corporation, the Chain O’Lakes Sportsman’s Club, and their directors, agents, members, tournament officials, officers, employees, and servants, and any other contributor, sponsor, or affiliate from all liability which might arise from any loss, damage, injuries, or death which I may sustain, and any theft, unexplained disappearance, or damage which may befall any of my property while en route to, during, and en route from the tournament. I further assume all responsibility for any guest that I may bring. I acknowledge that I am over the age of eighteen (18) and that I have previously participated in competitive shooting matches, and that I am aware of the risks and hazards inherent upon such events, including, but not limited to, accidental discharge of firearms and loss of property through misplacement or theft. I voluntarily assume all such risks. I acknowledge that I

have read and understand the USPSA/IPSC rules of practical shooting, and I acknowledge the right of tournament sponsors to terminate my participation immediately upon any failure of mine or of my guests to comply with all the rules, regulations, and directions of the tournament officials. I further state that I have read the foregoing participation agreement, and release and freely enter into it on behalf of myself and my distributees, heirs, next of kin, executors, and administrators.

By accepting this invitation to compete, I am authorizing USPSA and the Antrim Sand Pit Shooters, of  the Chain ‘OLakes Sportsman’s Club,  to use any photographs taken of me during competition in its promotional literature and advertising. I understand that this authorization does not extend to any other organization or business.

I HAVE READ AND AGREE TO COMPLY WITH THE TERMS of the Participation Release and Agreement.

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COMPETITOR SIGNATURE (PARENT/GUARDIAN IF UNDER 18)               DATE