Indemnity Form – all SADPA sanctioned matches & events, for duration of membership.

Full Names:	___________________________________________________________

I.D. NO:	___________________________________________________________

Tel. No:	________________________ Cell No: ________________________

Fax No:	________________________ E-Mail __________________________

Res. Address:	__________________________________________________________

__________________________________________________________

__________________________________________________________

Postal Address:	__________________________________________________________

__________________________________ Code: _________________

I, ____________________________ the undersigned, do hereby acknowledge and declare the following

I have enrolled for shooting events / training courses with the South African Defensive Pistol Association (SADPA)

I acknowledge that by its very nature, the events that I will participate in have potential hazards.

I accept that I participate in all SADPA sanctioned matches/events entirely at my own risk and hereby indemnify SADPA, it’s employees, agents or assigns and hold them harmless against any claim which may otherwise be brought by me, my executors, estate, dependants or assigns, arising out of any injury to me or my property which I may suffer as a result of any act or omission by the said SADPA, its agents or assign whether such act or omission is negligent or not and whether such act of omission takes place during the actual course of instruction or not.

I declare that I have never been declared unfit to possess a firearm, neither has any firearm in my possession been confiscated.

I undertake that any firearm which I may bring to the event shall be legally in my possession at the time.

I acknowledge that I have carefully read the above indemnity and sign same with full knowledge and understanding of its contents.

I acknowledge that I have carefully read the SADPA Range Rules and undertake to abide by same with full knowledge and understanding of the content.

_______________________	____________________

SIGNATURE	DATE

Insurance Cover for event by

Camargue Underwriting Managers (Pty) Ltd

Policy number: CGLP463907958

South African Defensive Pistol Association (SADPA)

PO Box 2501

North Riding

2162

South Africa

Tel:	+27-11-462-2088

Fax:	+27-(0)86-5658-354

E-mail:	enquiry@sadpa.co.za

SAPS Accreditation: SPORT 1300029, dated 8 Dec 2004

Adrian Rosslee

2010-03-03

nb123989

Corporate Security Systems