Gov Mohamad Dimaporo

Gov Mohamad Khalid Dimaporo Shoot
Name*

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Address*

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Birth Date*

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Mother Gun Club*
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IPSC Discipline*

HandgunPCC
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IPSC Division*

Open/OpticStandard/IronProductionProduction OpticsClassicRevolver
IPSC Category

Super Junior (below 14)Junior (below 18)LadySenior (50+)Super Senior (60+)Grand Senior (70+)Lady Senior (Ladies, 50+)
Special Category

Active Range OfficerInternational CompetitorLawman (PNP/NALECC)Executive
Preferred Squad Number*
I hereby signify that I am participating in this practical shooting competition under my own free will and do hereby absolve the organizers, the members, staff, and
officers of the PHILIPPINE PRACTICAL SHOOTING ASSOCIATION, officers and members of the NATIONAL RANGE OFFICERS INSTITUTE, match officials, from any injuries
that I may suffer during the competition, including any fatal injury that I may sustain. I further absolve all the above mentioned individuals should I contract COVID - 19
Coronavirus during the competition or at any time thereafter.
Please verify that you are human*
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Gov Mohamad Khalid Dimaporo Shoot