PHILIPPINE PRACTICAL SHOOTING ASSOCIATION

4/F Unit B Strata 2000 Emerald Ave. Ortigas Center Pasig City
Telephone No. 8-332-8210
Email: membership.ppsa1984@gmail.com

INDIVIDUAL MEMBERS APPLICATION FORM

Date Applied: November 26, 2020

New Member Renewal

PPSA ID No. Family Name First Name Middle Name

PAGATPAT LEONID PAQUIBOT

Nick Name : LEO IPSC Alias LEO

Birthday : MARCH 15, 1983 Birth Place DAVAO CITY
Civil Status : Single Married Gender MALE
Occupation : Blood Type: A B O

Membership Type Regular Honorary Life Membership Date:

:
RCS Classification :
Grand Master A B C D
NROI Ranking : Master
Range Chief Range Range
Officer Officer Master

Mother Club Name : ARMSCOR SHOOTING CENTER, INC. Position: MEMBER

Contact Information – Home
09272924427

Address : 3 SAN RAFAEL, ST., BRGY. KAPITOLYO, Zip Code : 1603

PASIG CITY Mobile No. : 09272924427

Email Address: leonidpagatpat@gmail.com Telephone No. :

Contact Information – Office
PHILIPPINE HEALTH INSURANCE CORPORATION

Address : 709 SHAW, BOULEVARD, PASIG CITY Zip Code : 1603

Mobile No. :

Email Address: Telephone No. : 441-7444

The information is, to the best of my knowledge, accurate and complete. I agree to conform to the Code
of Conduct, rules and policies of the PPSA and comply with the obligations of membership.

Endorsement:

2x2 ID Picture
Gun Club President
(Signature over Printed Name)

(Applicant signature should be inside the box)

Requirements: Membership Fees: Range Officers:

New Member Renewal A. Active Range Officers in Luzon who
A. Fill up Individual Membership Application Regular Member P 2,000.00 P1,000.00 have served a minimum of 36 points
Form Regular Junior 1,000.00 500.00 and 18 points in Visayas and Mindanao
B. Attach 2x2 colored picture – 1 pc Lawman (PNP, AFP) 500.00 500.00 RO are exempted from these fees as
C. Gun club President Signature Lifetime 10,000.00 NONE long they are endorsed by the NROI
D. Membership Fee Switch to Life N/A 9,000.00
NALECC 1,000 500.00 Secretariat
B. All Range Officers must be endorsed
-Lawman and NALECC must be present their by their Gun Club President
current active ID to avail the discounts. C. Policies may be changed by the PPSA
-Rates are subject to change without prior Board of Directors.
notice: