RETIRED

LEOSA/HR218 Concealed Handgun Qualification Course

Sponsored by Fraternal Order of Police Washington State Lodge & Evergreen Lodge 1 www.WAFOP.com www.fopevergreenlodge.org

Sunday, 24 September 2017, 1300-1500

at Bainbridge Island Sportsmen’s Club

8203 Sportsman Club Rd NE, Bainbridge Island, WA 98110

ELIGIBILITY This qualification is open to ALL retired Law Enforcement officers as recognized and defined under the Law Enforcement Officer’s Safety Act (18 USC 926C) and in accordance with RCW 36.28A.090. Cost is $10 for FOP Lodge 1 members , $20 other FOP members, and $50 for non-members. Remaining proceeds support the FOP Lodge 1 Dennis R. Allred Memorial Scholarship Fund. QUALIFICATION: This is a timed course of fire administered in accordance with the requirements set forth by the Washington Criminal Justice Training Commission consisting of 25 rounds fired from 3 to 15 yards using the BLEA-2 target. Minimum qualifying score is 175. You may qualify with multiple weapons and/or as many times as necessary at the discretion of the Range Master and/or subject to time constraints placed on range use by the host range. PARTICIPANT REQUIREMENTS: Shooters shall bring their own firearms, magazines, ammunition, and hearing and eye protection. (Recommend at least 50 rounds of ammunition per qualifying weapon.) FOP will supply ALL targets. For safety purposes, only factory-loaded ammunition will be allowed for use during this qualification. Please bring sufficient number of standard-size magazines* and/or Speed-strips/loaders to accomplish 25 round qualifications without delays and interruptions of other participants. (*Extended 20-30 round magazines are impractical for concealed carry and are not authorized for this event.) All firearms must be in good working order and will be inspected by staff prior to qualifications. Unsafe or illegally modified firearms are not permitted. Hip, belt slide, pancake, or paddle holsters are recommended. Soft (unreinforced) or Versa-carry-type inside the waist band holsters are not recommended and may cause delays re-holstering during timed shooting events. No pocket, cross-draw, shoulder holsters, SOB, or ankle holsters will be permitted. Body armor is not required. Deliberate unsafe acts will result in non-qualification and ejection from the range and forfeiture of fee. Dress appropriately for the weather, wear comfortable clothing, but not that would interfere with ability to draw and/or holster a weapon. REQUIRED CREDENTIALS: You must bring your agency-issued credentials or proof indicating you are “Retired” in good standing or otherwise meet the requirements of 18 USC 926C, and are eligible to carry; or are not disqualified from carrying a firearm. For military police officers; bring your DD Form 2 (Retired ID) and certified DD214 indicating you retired in one of the following Military Occupational Specialty codes and /or Officer Designator Codes; 31A-Officer, 31B-Enlisted and 31D-CID (Army), NOD 649 and 749, Master-at Arms Enlisted Rating (Navy), 5803, 5805-Officer, 5811, 5819, 5821-Enlisted (USMC), 31PX, S1SX-Officer, 3POX1-Enlisted (USAF). Coast Guardsmen Officers and enlisted designated as LE. All applicants must not be under any restrictions (Lautenberg -18 USC 922g) from possession of a firearm. *This event subject to change or cancellation dependent upon number of participants, refunds will be made for deposits if cancelled by FOP. Register at: http://www.fopevergreenlodge.org/Events.html For MORE INFORMATION Email wafop1@gmail.com or FOPLodge1WA@comcast.net

©2017, Fraternal Order of Police

©Fraternal Order of Police WA1, (2016)

Last Name, First MI Agency Retired Date Badge or ID#

Address City and State Phone EMAIL

FOP Member # SIGNATURE

/ƻǎǘΥ FOP Lodge 1 Members $10, Other FOP members $20, Non-Memberǎ $50

REGISTRATION Please submit this completed form via email to one of the addresses below or mail to: FOP, P.O. 3189, Silverdale, WA, 98383-3189, make checks payable to: FOP Evergreen 1. Email applications will not be accepted without payment verification via PAYPAL (see below link.) Mailed in application MUST be received no later than 3 working days prior to the event. Pre-registration is strongly encouraged as this event may fill quickly. While you may bring this form and payment on the day of the event, you will not be registered or guaranteed a reserved slot to qualify. You may pay in full via PAYPAL prior to the date of the event. Register at: http://www.fopevergreenlodge.org/Events.html

For more information email wafop1@gmail.com or FOPLodge1WA@comcast.net

QUALIFICATION: This is a timed course of fire is as required by the Washington Criminal Justice Training Commission consisting of 25 rounds fired from 3 to 15 yards using the BLEA-2 target. Minimum qualifying score is 175. You may qualify with multiple weapons and/or as many times as necessary at the discretion of the Range Master and/or subject to time constraints placed on range use by the host range. See the Course of Fire on the attached Qualification Form. Successful participants will be issued a signed wallet card.

PARTICIPANT REQUIREMENTS: Shooters shall bring their own firearms and ammunition, hearing and eye protection. (Recommend at least 50 rounds of ammunition per qualifying weapon.) For safety purposes, only factory-loaded ammunition will be allowed for use during this qualification.

Please bring sufficient loaded magazines and/or speed-loaders to accomplish 25 round qualifications without delays and interruptions of other participants. All firearms must be in good working order and will be inspected by staff prior to qualifications. Unsafe or illegally modified firearms are not permitted.

Belt slide, pancake, or paddle holsters are recommended. Soft (unreinforced) inside the waist band holsters are not recommended and may cause delays re-holstering during timed shooting events. No cross-draw, shoulder holsters, or ankle holsters will be permitted.

Deliberate unsafe acts will result in non-qualification and ejection from the range and forfeiture of fee.

Dress appropriately for the weather, wear comfortable clothing, but not that would interfere with ability to draw and/or holster a weapon.

REQUIRED CREDENTIALS: You must bring your Agency-issued credentials indicating you are “Retired” in good standing or otherwise meet the requirements of 18 USC 926C, and are eligible to carry; or are not disqualified from carrying a firearm. For military police officers; bring your DD Form 2 (Retired ID) and certified DD214 indicating you retired in one of the following Military Occupational Specialty codes and /or Officer Designator Codes; 31A-Officer, 31B-Enlisted and 31D-CID (Army), NOD 649 and 749, Master-at Arms Enlisted Rating (Navy), 5803, 5805-Officer, 5811, 5819, 5821-Enlisted (USMC), 31PX, S1SX-Officer, 3POX1-Enlisted (USAF). Coast Guardsmen Officers and enlisted designated as LE. All applicants must not be under any restrictions (Lautenberg) from possession of a firearm. *This event subject to change or cancellation dependent upon number of participants, refunds will be made for deposits if cancelled by FOP.

RELEASE OF LIABILITY All participants will sign a release of liability or have a waiver already on file at the time of the event.

LEOSA Handgun Qualification Course Registration

Waiver Attached [ ] Waiver on file [ }

LEOSA QUALIFICATION ASSUMPTION OF RISK AGREEMENT

WAFOP1 HR218/LEOSA Assumption of Risk Agreement 11/10/2015

All persons who attend in the Law Enforcement Officers Safety Act Qualification Shoot must read, understand, and sign this agreement, regardless of their participation. Your signature is binding, is considered a total hold harmless agreement, and affirms your understanding of this agreement and its intent. Complete and sign this form at the range prior to the shoot. Note that failure to sign the form will result in your disqualification. I understand I have been briefed on individual liability issues associated with carrying a concealed weapon and I have been provided a copies of the Law Enforcement Officer’s Safety Act (18 USC 926C) and RCW 36.28A.090 explaining the requirements, prohibitions and restrictions with carrying a concealed weapon within Washington State. Additionally, I understand that the regulations governing concealed carry vary from state to state and I am responsible for learning and abiding by these regulations. The undersigned assumes all responsibility for all risk of damage, injury or death that may occur to the undersigned as a participant in the LEOSA/ HR218/S-1132 Firearms Certification Course and associated and participation in range qualification exercises utilized by the course of qualification, practice or exercise, or while following instructions in or out of any course, facility or location, due to the negligence of the Fraternal Order of Police, any of its members or officers or the rangemaster, regardless of fault or negligence. In consideration of being accepted for participation in the LEOSA/HR218/S-1132 firearms qualification, the undersigned, for himself/herself his/her spouse, legal representative, heirs and assigns hereby releases, waives and discharges the Bainbridge Island Sportsmen’s Club, Fraternal Order of Police, any of its members or officers and the rangemaster, all of their officers, employees, agents, consultants, representatives, directors, successors and assigns for any and all loss or damage and any claims or damages resulting therefrom, on account of his person or property, even injury resulting in death of the undersigned, whether caused by the negligence of the Bainbridge Island Sportsmen’s Club or the Fraternal Order of Police or otherwise caused by or arising out of my voluntary presence or participation or the use of facilities, premises, firing range, equipment (including firearms and ammunition) during course practice or otherwise. The undersigned further agrees to indemnify the Bainbridge Island Sportsmen’s Club, Fraternal Order of Police, all of its members, officers, employees or associates or the rangemaster from any loss, liability, damage or cost that may occur due to the presence and activity of the undersigned in the use of firearms whether caused by the negligence of the Bainbridge Island Sportsmen’s Club or the Fraternal Order of Police, or otherwise. Further, the Fraternal Order of Police, and all others hold no liability for my use of the knowledge and information gained by me while in attendance and participation in this firearms qualification at this range. I hereby hold harmless the Fraternal Order of Police, and said persons from any claim by me, my family estate, heirs, or assigns arising out of my voluntary attendance and or participation course of firearms qualification. I acknowledge that I have read the rules and regulations dealing with the course and I have received instructions on the course presented and agree to comply with the rules, regulations, instructions and to follow any additional instructions, written or oral, that I may receive from the rangemaster or other persons present and in authority, representing the Fraternal Order of Police. Further, I acknowledge that it is possible that I may be exposed to blood or other body fluids during this qualification and that there is no way to predict or completely prevent this. I agree to follow the safety rules explained in the program's briefing to include keeping open wounds covered and dealing with blood. Should I release blood or other body fluids onto another person at this qualification, and I now know or later become aware that I am infected with any disease that can be transmitted through body fluids, I shall advise the rangemaster and the individuals onto whom I may have released body fluids. I have read the preceding section and specifically acknowledge and accept all risks which may be implied in receiving this qualification. In signing this release, I assert that I am presently in good physical and mental health; I have no reason to believe that I am not in good physical and mental health, I am fully aware of, and do acknowledge and accept all risk of injury inherent in my participation in this qualification. I have read and fully understand the terms and conditions of this agreement. I understand the terms and intent herein are contractual and not a mere recital and I have signed this release of my own free will. Dated this _______ day of _________________, 20______ at___________________________________________________ _________________________________________ ______________________________________ Printed Full name Signature

_________________________________________ ______________________________________ Witnessed by FOP Official Signature

SEQUENCE DISTANCE DESCRIPTION SHOTS TIME 1 3 Yards Draw and fire 4rds. (2 Body, 2 Head). Un-timed reload. 4 7 seconds

2 5 Yards Draw and fire 3rds using strong-hand only. Un-timed reload. 3 5 seconds

3 5 Yards From a Ready position, fire 3rds using support-hand only. Un-timed reload. 3 7 seconds

4 7 Yards From a Ready position, fire 5rds. Un-timed reload. 5 9 seconds

5 10 Yards From a Ready position, fire 5rds. Un-timed reload. 5 12 seconds

6 15 Yards From a Ready position, fire 5rds. Un-timed reload. 5 12 seconds

Total shots 25

INITIAL SCORE (BLEA MINIMUM; 175 PTS = 70%)

LEOSA Retired Law Enforcement Officers

INSTRUCTIONS: Unless otherwise directed the officer will begin each position of fire with handgun holstered and any retention devices properly secured.

Scoring of the course is based on the BLEA Tactical or similar type target. Any miss off the silhouette will result in a ten-point penalty for each. Hits on the silhouette but outside the scored area of the target and DNF’s (Did Not Fire) will result in zero points, but will not be penalized. Two hits are required in the Target Head, more or less than two hits will result in zero points for each additional round or missed round. (Revised 01 /31/14)

On the silhouette - outside the scored area No Penalty

Off silhouette – 10 Point Penalty