2019 SA State Titles International Practical Shooting Confederation (SA) Incorporated 2019 STATE HANDGUN CHAMPIONSHIPS IPSC Level III and SA State Team Inter-Club Selection (STICS) Match 12 Stages (plus Chronograph) - Minimum 220 Rounds Adelaide Pistol & Shooting Club Mallala Road, Korunye, SA 5502 25 (pre-match) 26 & 27 January 2019 ENTRANT'S PARTICULARSName* First Last IPSC Membership Number*Date of Birth* IPSC Section*ACTNSWNTQueenslandSAVictoria/TasmaniaWAInternational VisitorIPSC Region (IF NOT AUSTRALIA)*AustraliaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweContact Phone (Mobile preferred)*Email* Enter Email Confirm Email MATCH ENTRY Division*OpenStandardProductionProduction OpticsProduction Optics LightClassicRevolverCategoryLadySeniorSuper SeniorJunior (under 21 on first day of match)Super Junior (under 16 on first day of match)Rookie - Ist Level III Match? Rookie Grade*GMMABCDUngradedPower Factor*MajorMinor CATERING Breakfast - will be available for purchase from 7.00am each day. Lunch - a selection of items will be available for order and purchase daily. MATCH FEES & PAYMENT Received on or before Friday 18 January 2019 - Full $90, Age Concession $75, Family $75, Juniors aged 18 and over $50, under 18 free. Received on or after Saturday 19 January 2019 - All classes $150. Payment online may be made by Credit/Debit Card (Visa or MasterCard only). Payment may be made by EFT or Direct Deposit to |Bank NAB | Account Name IPSC (SA) Inc | BSB 085 443 | Account No 489217992 | Reference <Your IPSC No> <Your surname>. Email your Proof of Payment if paid by EFT or Direct Deposit to firstname.lastname@example.org CONDITIONS OF ENTRY (The Small Print) Closing Dates - Entries will be accepted up to 6.00pm on Thursday 24 January 2019. No entries will be accepted after this time - no exceptions. All entries received on or after Saturday 19 January 2019 will attract a fee of $150 for all classes. Entries - Entries will not be processed until correct payment has been received and cleared. Withdrawals - Withdrawals prior to 19 January 2019 will be eligible for a refund less an administration fee of $10 per entry. Withdrawals on or after 19 January 2019 will be eligible for a refund less an administration fee of $25 per entry. Failure to attend on the day will result in forfeiture of all fees unless deemed exceptional circumstances as judged by the Executive of IPSC(SA). Registration - Registration will be open Thursday 2.00pm - 4.00pm & Friday 12.00pm - 5.00pm. Registration on the Saturday will be strictly by prior arrangement only - please advise email@example.com. Start Times - The Competitors Briefing will be at 8.15am on Saturday. The match will start each day at 8.30am. Monitor the IPSC(SA) website www.ipscsa.asn.au for updates to these times. Licences and Permits - Competitors must carry their home state-issued Firearms Licence on their person at all times whilst in possession of a firearm in SA. Squadding - Requests for specific squadding may be made by email to firstname.lastname@example.org. Final squadding will be at the sole discretion of the match organisers and requests cannot be guaranteed. Entries on or after Saturday 19 January 2019 will be placed into squads as available. Enquiries - All enquiries concerning entries should be sent to email@example.com. ADELAIDE PISTOL & SHOOTING CLUB - Specific Rules No Full Metal Jacket bullets are to be used on the stages. Frontier Complete Metal Jacket bullets are permitted. No camouflage or camouflage-like clothing is permitted on the ranges. No firearms may be worn in the Clubhouse - all firearms taken into the Clubhouse must be safely bagged. Release & Waiver* By ticking this box and submitting my entry, I certify that I have read and accept the Release and Waiver that can be found on the IPSC(SA) website www.ipscsa.asn.au Licences and/or Permits* By ticking this box and submitting my entry, I certify that I hold the necessary licence(s) and/or permit(s) to be in possession of and utilise for Purpose 1 (Club Use) an H-Class firearm in the State of South Australia Conditions of Entry* By ticking this box and submitting my entry, I acknowledge that I have read and accept the Conditions of Entry FEE PAYMENT I am paying the following fee*Full $90Age Concession $75Family $75Junior aged 18 and over $50Junior under 18 and Super Junior- no feeSelected RO - no feeLate fee - $150 (after 18 January 2019)If paying by Credit/Debit Card, please WAIT after selecting the submit button TO BE TRANSFERRED TO THE PAYMENT PAGE.I am paying by:*EFTDirect Deposit (over the counter)Credt/Debit CardNo Payment RequiredPhoneThis field is for validation purposes and should be left unchanged.