Whitewater Range Application – Action Pistol Group

Name

Address

Phone

Membership Type

Individual ($90)

Family ($150)

Qualification for membership

Graduate of Advanced Action Pistol Group Class

Active IDPA SO or USPSA RO (attach current certificate)

IDPA or USPSA Member (attach current member card)

Date of Class

Upload File Containing Scan of IDPA/USPSA Card

Upload

Date of First APG Competition

Date of Second APG Competition

Board Member Recommendation By:

Term of service

I agree to the RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF RISK AGREEMENT

Date

Signature

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