NAVIGATION
Black Badge Course Application
Full Name
Preferred Course Location
Street
City/Town
Province
Email Address
Bus. Phone
Cell Phone
Postal Code
Res. Phone
Fax
Refresher
First Course
GEBERAL INFORMATION
I am at least 18 years of age
If you have any physical condition that might affect your performance on this course? If yes, please explain.
If you would like to participate in one of our IPSC Black Badge courses, please complete the Course Registration Form below and an Instructor from your area will get back to you to discuss the course requirements with you.
Please use your TAB key or your MOUSE to navigate the fields on this Registration
Form. If you accidently hit ENTER at any time, the form will be automatically sent and
you will have to begin again. When you've finished, simply use the "Send It" button.
Please list any other firearms courses you have
successfully completed.
How long have you been shooting handguns?
Indicate the (make, model and caliber) of the
firearm you will be using for this course.
Does this firearm have an electronic sight?
Yes
No
List any modifications to this firearm
Are the controls such as the Safety and Magazine
Release easily manipulated on this firearm?
Yes
No
Approximatel how many rounds
have you fired from this firearm?
Less than 500
More than 500
More than 1000
How many Magazines or Speedloaders
do you have for this firearm?
1
2
3
More Than 3
What type of holster will you be using with this firearm for the Black Badge Course?
Comments: Anything you would like to ask of, or
say to the Instructor of this Black Badge Course.
