ELIGIBILITY AFFIDAVIT AND LIABILITY AGREEMENT

A. To establish my eligibility under section 40723 title 36 United States Code to participate in any activity sponsored or supported by the Civilian Marksmanship Program (CMP), I hereby certify that:

1. I have not been convicted of any Federal or State felony or violation of section 922 of title 18 United States Code, and

2. I am not a member of any organization that advocates the violent overthrow of the United States Government.

B. In consideration for being permitted to participate in any activity sponsored or supported by the Civilian Marksmanship Program I hereby agree to:

1. Be bound by the Civilian Marksmanship program Competition Rules,

2. Waive any claim against the Corporation for the Promotion of Rifle Practice and Firearms Safety and any other organization sponsoring or supporting the match for any personal injury, loss or damage that I might suffer in connection with the match, and

3. Defend, indemnify and hold harmless any organization sponsoring or supporting the match from any claim of a third party arising from any negligent or wrongful conduct by me.

Signed:_______________________________________ Date:______________

Name (print): __________________________________

Address: _________________________________

_________________________________

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STATE OF ____________________________                            SS: ______________________

CITY/COUNTY OF _____________________

BEFORE ME, the undersigned Notary Public, appeared the person making the above certification and agreement, who under oath stated that he/she has read, understands and agrees to it, and that the certification is true and correct to the best of his/her knowledge.

SUBSCRIBED and SWORN TO before me, the undersigned Notary Public, on this _____day of________________, 20___.

Notary Public ____________________________ My commission expires:____________