Region of Residence:  Select Argentina Aruba Australia Austria Belgium Brazil Canada Chile China Colombia Czech Republic Denmark Ecuador Estonia Finland France Germany Greece Guam Guatemala Hong Kong Hungary Indonesia Ireland Israel Italy Japan Lithuania Macau Malaysia Monaco Netherlands New Zealand Norway Papua New Guinea Philippines Poland Puerto Rico Russia Serbia Singapore Slovak Republic South Africa Spain Sri Lanka Sweden Switzerland Taiwan Thailand Ukraine United Kingdom United States Uruguay Venezuela Zimbabwe

Family name:     Other Names: 

Enter your name above exactly as it appears in your passport!

Date Of Birth:  Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928        Gender: Male Female

Cellular: +  Email: 

International format +1 555 2223737 (country-area-number) for phones!

No:   Country:   Expiry: Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Your passport must be valid for at least 6 months from your arrival in Indonesia!
If you are applying for a new passport, submit your current passport details now,
and bring both passports with you when you fly to Bali.

Show my First Name (or initials) on Match Results as:

Surname:    First Name: 


Division: Select Open Division Standard Division Modified Division Production Division Revolver Standard Division   Category: If applicable Lady Junior Senior Super Senior

Teams can only be registered by your Regional Director.

I'm:a Sponsora Regional Directorworking WSXV as a Match Official

IPSC Alias:     T-Shirt: Select (American) size Small Medium Large XL 2XL 3XL 4XL

Issue the permit in: my name my delegate's name:

Your delegate's name above must match the name on his/her passport!

Make:    Model:    S/N:    Calibre:  Select 9mm (any) .38/357 .38Super .40/10mm .45
Make:    Model:    S/N:    Calibre:  Select 9mm (any) .38/357 .38Super .40/10mm .45
Make:    Model:    S/N:    Calibre:  Select 9mm (any) .38/357 .38Super .40/10mm .45

Permit will include approval for 1,000 rounds of ammunition per person.

If you're travelling on the same flight with a companion who is not bringing
ammunition, and you'd like an extra permit in their name for use during
check-in at your airport of origin, enter their name in the box below.

Companion:  

I need to order 600 rounds of:

9x19mm for US$270
38 Super for US$300
38 SuperComp for US$300
40SW for US$300


     Additional quantities can be purchased at the range, if and when necessary.

I fly directly to Bali on Flight    on    October

-- OR --

I fly first to Jakarta on Flight    on    October

then I fly across to Bali on Flight   on    October

WSXV IROA Range Officials: Don't book your room in this section!
See the IROA Rooming page.

Please book me one no-smoking room smoking room,
with one large bed two single beds three single beds

  at Ramayana Resort & Spa - US$66 per night  for   nights

Note that "one large bed" could be a Double, a Queen or a King size bed,
dependant upon availability at the hotel requested. If you intend to
share a room with one or more other competitors, only one of you
should book a room.

If you have special requests of the hotel, add them here:



Hotel requests are handled on a "first come, first served" basis, and registration
does not guarantee room or rate availability, which is subject to confirmation.

I fly direct out of Bali on Flight    on    November

-- OR --

I fly firstly to Jakarta on Flight    on    November

  then I fly out of Jakarta on Flight    on    November

By clicking the Submit button below, I indemnify and hold harmless IPSC, it's Officers, all organisations affiliated to IPSC and all their Officers, IPSC Indonesia and it's Officers (including all managers, employees, contractors, agents and servants), and all other persons or entities directly or indirectly involved in organisation of the Match, in respect of all and any delay, loss, damage, accident, injury, disability or death suffered by me, and/or any other person accompanying me, arising for any reason, while travelling to or from Indonesia, and while in Indonesia.

I agree to the above disclaimers

    

WARNING! If you click the Reset button, ALL data entered above will be cleared!