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ICORE Rule Book |
A printable booklet version of the ICORE Rulebook is available by clicking on the link. Download and print as double sided (flip on short edge) then fold and staple.
8th Edition
ICORE Rule Book
last revised 8 November 2010
Dedicated to Wheel Gunners of
all kinds
and
Promoting Revolver Competition
Table of Contents
3
DEFINITIONS OF FIRING POSITIONS / STYLES
The
most current rules are posted on the I.C.O.R.E. website. The posted rule book
supersedes any and all printed materials and prior printed rule books.
Welcome to ICORE!
ICORE is
dedicated to Wheel Gunners from every walk of life and for every purpose: from
collectibles to competition. Your membership is a valuable way to insure the
continued success of the wheel gun, both for sports and other interests. Thank
you for your support.
Please read
through this entire booklet so that you may become very familiar with the rules
and regulations involved in this shooting sport. We have done our best to
insure that the format is easy to follow and to understand. Since your
membership is the key to our organization, we want your input and appreciate
your comments regarding the contents of this book. A lot of research has gone
into the wording, layout and style; but we anticipate revisions in the future.
You will help shape ICORE as we grow.
While learning
the various aspects of these rules keep in mind that our basic intent is
safety, fairness and fun. If you have a question about a rule, base your
decision on these principles.
Thank you again
for your membership. We look forward to seeing each and every one of you at an
ICORE sponsored event so that we may meet the people that are making ICORE a
strong, viable force that will continue to support the revolver in all its
glory.
Our Sincere Regards,
Michael and Sharon Higashi
ICORE founders
1 SAFETY
1. All persons,
competitors or spectators must wear eye and ear protection while participating
or viewing events.
2. Every new
shooter must be cleared with the Match Director as having a basic knowledge and
be able to use the knowledge to be a safe competitor.
3. ICORE
functions on a "Cold Range" basis for safety. Unloaded firearms may
be handled in designated areas only. Firearms may only be loaded or unloaded at
the direction of Range Officers. Violators face disqualification from the
match.
4. Any shooter
whose firearm breaks the 180 during the course of fire will face
disqualification. The 180 is an imaginary line separating up range from
downrange. This line moves with the shooter throughout any course of fire.
5. Accidental
discharges impacting within 3 meters of the shooter, while reloading, between
shooting areas, or in a direction deemed unsafe by the Range Officer will
result in disqualification from the match.
6. Any shooter
who displays disruptive behavior or is abusive (verbal or otherwise) towards
any other person at that match will be disqualified.
7. Any shooter
found to be under the influence of any drug or alcohol immediately before or
during the match will be disqualified.
8. Dropping an
unloaded firearm behind the firing line necessitates that a Range Officer pick
it up, confirm it is not loaded, and in a safe manner return it to the shooters
bag, holster or vehicle. Any dropped firearm found to be loaded would cause the
shooter to be disqualified. If at anytime during the course of fire, or while
loading, reloading or unloading, a competitor who drops their firearm or causes
it to fall, loaded or not, will be disqualified.
9. All persons
at the match must obey Range Officers with respect to the shooting competition
and safety rules. Any shooter failing to do so will be disqualified and removed
from the shooting area. Any person failing to observe this rule will be removed
from the shooting area.
10. Unsafe gun
handling by a competitor during a match may result in disqualification from
that match. Unsafe gun handling may include but is not limited to accidental
discharges, sweeping, shooting over confining berms, and any other actions
deemed unsafe by the match staff.
11. Whenever Steel targets or Steel hard cover are used in a course
of fire, precautions must be taken so that competitors, Match Officials, and
spectators maintain a minimum distance of 23 Feet or 7 Meters from them while
they are being shot. Steel targets should never be presented at an angle greater
than 45 degrees. This is to prevent possible ricochets. (Section added 11 Oct
2010)
2 RANGE COMMANDS
ICORE has based
its range commands on the assumption that the shooters will present themselves
to the starting position with their firearm unloaded and holstered, prepared to
shoot the course of fire. The course of fire will be explained to the shooters
by a complete written description of the course of fire and/or by a walk
through from the Chief Range Officer. It is the shooter's responsibility to
understand the course of fire. The CRO will invite the shooter to the starting
box or area and give the following commands:
1. "Load and
Make Ready" or "Make Ready" (for starts with an unloaded
firearm). Either command will be suitable as not all stages are started loaded.
The shooter may now take a sight picture if they so desire, prepare the
revolver in accordance with the written course of fire, and assume the starting
position as defined in the course of fire. This command signifies the start of
"Course of Fire."
2. "Are
You ready?" - The CRO asks if the shooter is prepared to proceed. If the
shooter is not ready to proceed, it is the shooter's responsibility to inform
the CRO that they are not prepared. When the shooter does not respond
negatively to this question, the CRO will assume the shooter is ready.
3. "Stand
By." - This is the verbal signal given by the CRO to the shooter that the
start signal will follow soon.
4. Start Signal
- The signal for the shooter to start the course of fire will most often be an
audible signal from an electronic timing device. However, other options can
include visual, verbal, or other start signals that must remain the same for
all shooters that execute the course of fire.
5. "STOP"
- Any Range Officer assigned to a stage may issue this command at any time
during the course of fire. The competitor must immediately cease firing, stop
moving, and wait for further instructions from the Range Officer.
Once the
shooter has apparently completed the course of fire, the CRO will issue the
following commands.
6. "If you
are finished, unload and show clear." - If the shooter has finished the
course of fire, they will then remove all ammunition from the revolver
cylinder, and hold the firearm in a position that allows the CRO to confirm the
firearm is unloaded.
7. "If
clear, close cylinder, holster" - After issuance of this command, the
competitor is prohibited from firing. While pointing the handgun safely
downrange, the competitor must perform a final safety check of the handgun as
follows: Close the empty cylinder, and
holster.
8. "Range
is clear." - This command given by the CRO indicates the range is safe. No
one should move forward on the range to perform range duties until this command
is given. This command signifies the end of "Course of Fire".
3 DEFINITIONS OF FIRING POSITIONS / STYLES
1. Free style -
being the shooter's choice, generally standing supported, kneeling or prone,
etc., firing position.
2. Strong hand
- in the case of a right handed person this would mean their right hand only,
unsupported by their opposite hand. All
functions must be performed by this hand alone with the exception of reloading,
clearing malfunctions or unloading.
3. Weak hand -
in the case of right handed person this would mean their left hand only,
unsupported by their opposite hand. Draws must be using the strong hand, the firearm will then be
transferred to the weak hand and firing may commence. Drawing, reloading, clearing malfunctions or
reholstering may be done with the assistance of the strong hand.
4. Kneeling -
is defined as having a minimum of one knee on the ground.
5. Prone - is
defined as body horizontal to the ground.
4 STAGES
1. Stages must
be set up in a safe manner, without presenting a hazard to any shooter. You
must take into consideration ricochets, ground hazards, visibility, local
shooters abilities and any other item that may constitute a problems such as,
180's, shoot throughs etc. NOTE: The stage layout must be 6 round neutral. The Match Director of each event is
responsible for this.
2. Each stage
must be presented to every shooter in the same way: Shooting areas, target
arrays, target types, props, range commands, etc. Every controllable aspect of
the course of fire must be the same for every shooter at the match.
3. Stages and
their descriptions must be set up clearly. Make things easy to understand. Shooting boxes and/or areas and fault lines
must be easy to distinguish from the surrounding area. Props are up to the
course designers and Match Directors. Keep in mind that you want people to
enjoy the challenge.
4. Props must
not provide any danger to the competitor. Any prop that is used that requires maneuvering completely over, around,
through or under must have an alternative procedure available for those that
may be physically unable to follow the directed course procedure. No penalty is
to be assessed if the shooter gains no advantage.
5. The stage
design or description may dictate reloads, engagement sequence, firing
positions, and firing styles.
6. The course
may designate a specific or limited number of shots to be fired during the
string or stage, this is called "Shots Limited" as "Virginia Count"
is in IPSC. If no set time or maximum number of shots are indicated by the
course design the shooter may use the extra shots and time to better their
score, this will be referred to as "Shots Unlimited".
7. The
classifying stages sent to each ICORE club and used for the purpose of
obtaining classification within the ICORE organization must be set up exactly
to the specified dimensions. Since these
stages are used world wide to find proper classes for our shooters, they must
be set up identically.
5 EQUIPMENT
1. All firearms
used in ICORE matches must be revolvers with a .32 magnum caliber or greater
and in sufficiently safe condition. All firearms are subject to inspection and
approval by the Match Director or Range Officers.
2. Ammunition
must produce a minimum power factor of 120000. The power factor equals bullet weight in grains
multiplied by velocity in feet per second. All competitors may be tested for
minimum power factor at any ICORE match. Six rounds will be collected from each
competitor at random during the match and at least one of those six must equal
or exceed a 120000 power factor when shot over a chronograph through the
competitor's firearm. A seventh round may be collected and weighed, to accurately determine bullet
weight. "FAILING TO MAKE CHRONO" will result in 360 seconds being added to a competitor's
score. A competitor, using a revolver chambered in .38 Special and/or .357
Magnum and using factory new UMC 158 grain, Remington 158 grain, Blazer 158
grain, or Federal American Eagle 158 grain ammo, may compete without regard to
power factor.
3. ICORE
requires a holster that will securely hold your firearm. The holster must cover
the trigger guard area. Holsters must be
attached to your gun belt. The heel of the butt of the gun is not allowed below
the bottom of the belt. (An exception shall be duty rigs and single action
rigs.) Tie downs are allowed on single
action rigs only. The Match Director may require a "holster test".
With the gun/belt/holster assembly attached to the tester's waist, the revolver
must be retained in the holster when the tester hops. During this hop, both of
the tester's feet must clear the ground, the tester's heels must clear the
ground by at least 3 inches and the tester may not hold or touch the revolver.
All retention devices on the holster used to pass the holster test must be
similarly engaged at the start of every course of fire.
4. ICORE
requires a belt sufficiently strong enough to hold your holster and loaders in
a safe manner. The belt is to be worn
about the waist. Women may wear theirs at hipbone level.
5. ICORE
requires sufficient loaders and loader holders as necessary to complete the
stage at hand. The holders must be attached to your gun belt. You may do your initial loading from pockets
prior to beginning the course of fire. However during the course of fire all
reloads must come from your belt, unless otherwise directed by the course of
fire or at the direction of the Match Director or Range Officers. During the
course of fire, you may safely retrieve any ammo that has been dropped.
6. A revolver
must compete in the Open Division if it has one or more of the following
modifications:
A.
Compensating, venting, or metering
ports of any kind.
B.
An optical sight including telescopic
and red dot sights.
C.
A rib sight, a front sight that extends
beyond the muzzle, or a rear sight that extends beyond or behind a factory
manufactured sight's location.
D.
Any barrel other than an unaltered
factory barrel or an unaltered factory replacement barrel made by the revolver's
manufacturer. Alterations to the barrel
other than what is required to safely install the barrel are not permitted in
Limited Division.
E.
An underlug, barrel weight, grip
weight, or any other modification designed to increase the weight of the revolver.
7. Any revolver
not competing in Open Division may compete in Limited Division or Classic
Division subject to Rule 5.8 and 5.9.
8. A Classic
Division revolver is a Limited Division revolver that has the following
additional requirements:
A.
Cylinder with only 6 chambers.
B.
Must only use speed loaders to reload.
Moon-clips are prohibited.
9. A revolver
may only compete in a single Division that must be declared prior to the start
of competition.
6 TARGETS/SCORING
1. The official
target of the ICORE organization is the NRA D-1 target. The X-ring is the
4" zone in the middle of the target. The X-ring and the next zone outside
of that constitute the A zone. The next is the B zone, the balance of the
target is the C zone. The X-ring may be
used as a tie breaker or bonus zone. Portions of the NRA D-1 target may be
painted black to represent impenetrable hardcover. Portions of the D-1 scoring
area may be painted or covered with an overlay to represent penetrable
softcover or a special scoring zone. Scoring area paint or overlays may be any
clearly contrasting color except white. Hardcover and softcover shall not be
used simultaneously on a target. Scoring zone perforations shall always be used
to determine the bullet score regardless of paint or soft cover boundaries. A
D-1 target may also be painted white or taped with a large black X of 1 inch
(2.5 cm) minimum width over the entire target to indicate a non-engageable
No-Shoot target.
2. Standard
height for paper means the top of the target is set at 5' 6" from the
ground. For plates the top of the plate
is at 4' 6" from the ground. The
top of 18" X 24" rectangles are at 5' from the ground. Those targets set at "ground" level
must have the bottom of the target within 12" of the ground.
3. Hard cover
is defined for scoring purposes, as an impenetrable barrier placed closely to
and partially in front of a shoot target, or a NRA D-1 target with impenetrable
portions painted black, any rounds passing through hard cover into the shoot
target would be scored as a miss. Any round passing only partially through the hard cover and through the shoot
target will be considered as a hit. Both shoot targets and no shoot targets are
considered impenetrable. A full diameter hole in either, made by a shot
subsequently striking a shoot or no shoot target downrange will be scored as a
miss on the down range target. If the down range target is a no shoot target,
no penalty is incurred. (Note: If the RO cannot determine which hits on the
down range target are the result of a shoot through, more hits on the down
range target then what were shot through a target or hard cover, the shooter is
given the higher score.)
4. Soft cover
is a penetrable vision barrier through which shots may pass and be scored on a
shoot target. Soft cover may be placed in front of the scoring target or
attached to the scoring target as an overlay or painted area. Scoring zone
perforations shall always be used to determine the bullet score regardless of
paint or soft cover boundaries.
5. No-shoots
are targets that are indicated as a non-engageable target. Only full bullet
diameter shots will count as a penalty.
6. Scoring is
done on a "total time" basis. The accumulated time of all runs, plus
target hits, plus penalties equal total time. That will be the score. On the D-1 targets A zone hits add 0 seconds,
B zone hits add 1 second, and the C zone adds 2 seconds. If a hit breaks the
perforation, the shooter is given the better score. Targets that disappear
completely during the course of fire are only susceptible to miss penalties and
will not incur penalties for failure to engage. Moving targets that have some
portion of the scoring area remaining visible are susceptible to both miss and
failure to engage penalties. Steel targets are scored as a simple hit or miss.
Knockdown targets must be knocked down to score as a hit.
7. The
following penalties may be assessed during scoring:
|
1. |
Miss |
5 seconds |
|
2. |
Hitting No Shoot |
5 seconds per hit if hole is a full
bullet diameter inside the edge of No-Shoot. |
|
3. |
Premature start |
5 seconds. |
|
4. |
Foot Fault |
5 seconds. |
|
5. |
Failure to Engage |
5 seconds per required target
engagement that was omitted. FTE shall not apply for any steel target not
engaged due to hitting Stop Plate out of order on a standing steel-only
stage. FTE shall not apply for any target not engaged due to Par Time
expiration. |
|
6. |
Procedural |
5 seconds. |
|
7. |
Extra shot |
5 seconds (Shots limited). |
|
8. |
Extra hit |
5 seconds (Shots limited). |
|
9. |
Overtime shot |
10 seconds (Fixed time stage). |
|
10. |
Failure to hit Stop Plate |
30 seconds. |
8. It is the
Range Officer's responsibility to insure that scoring for their stage is done
properly. Each shooter is responsible for signing their score sheets after they
have reviewed it for completeness and accuracy.
9. No shooter
or spectator may touch any target until it is scored. Any person doing so may
be disqualified from the match.
10. If at
anytime a competitor is unable to finish a stage or string because of the
competitor's equipment failure (i.e. barrel blockage, firearm breakage, etc.),
the competitor will be scored his time and hits for the course of fire until
the breakage, and awarded ALL penalties for misses, failures to engage, and any
other procedural penalties appropriate to the stage or string.
11. If a
competitor is unable to finish a course of fire containing multiple strings
because of the competitor's equipment failure (i.e. barrel blockage, firearm
breakage, etc.), the competitor will be awarded penalties as described in
Section 6, Rule 10 for that string. If additional strings are required to
complete the course of fire, the competitor may finish the required strings if
repairs or replacement can be effected within 30 minutes. If the competitor
cannot effect repairs or replacement within 30 minutes, penalties are awarded
as described in Section 6, Rule 10 for each remaining incompleted string.
12. In the
event of breakage, a competitor may complete the match with an
"equivalent" revolver after receiving express permission from the
Match Director to make the substitution. Any change in ammunition may be
checked to assure it meets minimum standards.
13. Calibration
of Poppers
- The Match
Director and/or Range Master must designate a specific supply of
ammunition and a specific handgun(s) to be used as official calibration tools
prior to the start of the match.
- It is the
responsibility of the Match Director and/or Range Master to ensure the
designated calibration handgun and ammo does not exceed a power factor of
120.0. The power factor should be determined from an average of 3 bullets
using the declared bullet weight.
Once the
designated handgun and ammunition have been approved by the Match Director
and/or Range Master for use by themselves or Range Officers they are not
subject to challenge by competitors.
- Prior to commencement
of a match, all steel poppers should be calibrated to fall when hit within
the calibration zone. The shot
should be fired from the shooting location in the course of fire farthest
from the popper being calibrated. The popper must not be engaged at an angle greater than 45
degrees. Steel poppers should be
painted before each shooter starts the course of fire.
The calibration
zone is the continuation of the radius determined by the widest circular
portion of the popper. (See Figure 1, Popper
Calibration Zones)
- Calibration
Challenges
If, during a
course of fire, a popper does not fall when hit within the calibration zone, a
competitor has three alternatives:
a.
The
popper is shot again until it falls. No
further action is required and the course of fire is scored as shot.
b.
The
popper is left standing but the competitor does not challenge the
calibration. No further action is
required and the course of fire is scored as shot, with the subject popper
scored as a miss.
c.
The
popper is left standing and the competitor challenges the calibration. The
popper and the surrounding area on which it stands must not be touched or
interfered with by any person. If a Match Official violates this rule, the
competitor must reshoot the course of fire. If the competitor or any other
person violates this rule, the popper will be scored as a miss and the rest of
the course of fire will be scored as shot. If the popper falls for any
non-interference reason (e.g. wind action), before it can be calibrated, a
reshoot must be ordered, and is mandatory.
- In the absence of
any interference, or problem with a target mechanism, the calibration test
of the subject popper should be done from as near as possible to the point
from where the competitor shot the popper.
The following will
apply:
a.
If the
first shot by the calibration officer hits on or below the calibration zone and
the popper falls, the popper is deemed to be properly calibrated, and it will
be scored as a miss.
b.
If the
first shot fired by the calibration officer hits the popper anywhere on its
frontal surface and the popper does not fall, the calibration test is deemed to
have failed and the competitor must be ordered to reshoot the course of fire,
once the popper has been recalibrated.
c.
If the
first shot fired by the calibration officer hits above the calibration zone,
the calibration test is deemed to have failed and the competitor must be
ordered to reshoot the course of fire once the popper has been recalibrated.
If the first shot
fired by the Range Officer misses the popper altogether, another shot must be
fired until one of a, b, or c, occurs.
(Section added 25 Oct 2010)
Figure 1 - Popper Calibration Zones
7 PROTESTS
1. Competitor
protests regarding scoring and/or Range Officer's decisions must be made
verbally, first to the Range Officer in charge of the stage, then to the Range
Master, or the Match Director if there is no Range Master. If no consensus can
be reached, a written protest along with a protest fee of double the normal
match fee or $100, whichever is less, must be submitted to the Match
Directorwithin one hour of the verbal protest. The Match Director will choose an Arbitration Committee. It will consist
of one Match Official and two competitors. The Match Director, Range Master,
and the involved Range Officer cannot be on the Arbitration Committee. The
Committee's decision must be made before final match scores are posted. The
Committee's decision must be in writing and is final. If the protester
prevails, the fee is refunded, if not, the Match keeps the fee. All written
protests and written decisions, whether won or lost, should be sent to the
rules director within 60 days.
2. If a shooter
has a protest they are not to sign the score sheet.
8 RESHOOTS
Reshoots are
mandatory under the following circumstances:
1. Range
equipment malfunction.
2. If a Range
Officer mistakenly stops a shooter for a suspected safety problem, and the
problem was not real. Safety concerns that are not of the shooter's doing will
also be grounds for a reshoot.
3. When the
Stage has been finished and the score sheet that is given to the competitor is
not completely or correctly scored.
4. When the
Range Officer and the Match Director concur on special circumstances for
granting a reshoot.
5. When a competitor is ordered to
reshoot a course of fire based on the decision of a popper calibration
challenge (See Rule 6.13). Also when all targets are not taped, restored and
reset prior to the competitor starting the course of fire. (Section added 8 Nov
2010)
9 CLASSIFICATIONS
1. For the
purposes of ICORE classification, the
following scale will be used for Limited, Open and Classic Divisions:
|
95% to 100% |
Grand Master (GM) |
|
85% to 94.999% |
Master (M) |
|
75% to 84.999% |
A |
|
60% to 74.999% |
B |
|
45% to 59.999% |
C |
|
0% to 44.999% |
D |
Percent calculations are rounded down to 3
decimals.
2. ICORE
classification will be determined from the average score of the three best
classifiers on record. To become ICORE
classified in either Limited, Open or Classic division four classification
stages must be shot and submitted for each division. The absolute top score
will be disregarded for classification purposes.
3.
Classifications will be reviewed on an annual basis and your classification
depends on your membership being current.
4. If adequate
classifiers are shot, an ICORE member may maintain distinct classification(s)
in Limited, Open and Classic Division.
5. A member
retains the highest classification he has earned. Anyone can request a move up
or down in the classification system. Submit your request to the ICORE
Statistician with a supporting letter from a club officer or range officer. It
will be considered based on the scores over the past twelve months. Only one requested move will be honored per
year. You may also request a review of someone else's classification.
6. Your ICORE
classification may reflect finishes in ICORE sanctioned larger matches.
7. At the match
director's discretion, the Lewis Scoring System may be used at all ICORE
sanctioned events, particularly at ICORE regional matches. ICORE's version of
the Lewis System assigns a class to each shooter in a match after the match is
completed and all final scores are tallied. The 100% performance mark will be
the top Open and/or the top Limited shooter's time for the match. Shooters that
shoot between 95% and 100% of the 100% performance mark are assigned to Grand
Master class. Shooters that shoot between 85% and 94.999% of the 100%
performance mark are assigned to Master class. Shooters that shoot between 75%
and 84.999% of the 100% performance mark are assigned to "A" class,
and so on through the remaining classes. If the Lewis System is not used, a
separate class for unclassified shooters must be used and all shooters in this
class will shoot "heads up". (Note: ICORE intends that the Lewis
System only be used at a match where there is a high percentage of unclassified
shooters.)
8. In order to
claim a prize gun at an ICORE sanctioned event, a shooter must be an ICORE
member. A non-ICORE shooter may walk the prize table in the order of finish
designated by the Match Director, but may not be awarded a gun at an ICORE
sanctioned event.
I.C.O.R.E Rule Change System
ICORE is, and
must be, an organization driven by the membership. This is particularly
important regarding the rule book which, until recently, has been the sole
responsibility of the Board of Directors.The Rules Director suggested the
following procedure to the Board of Directors on 22 Nov 97, it was approved by
the BOD, and an "I.C.O.R.E Rule Modification" form was included in
the 4th edition of the rule book:
1.
Copy the form from the back of the rule
book, fill out the copy and forward it to the Rules Director. The Rules
Director will review it and return an initial response as to whether the
proposal will be submitted to the BOD for a review/vote.
2.
If the Rules Director determines that
the proposal warrants submitting to the BOD, he will forward it, along with his
recommendation regarding the rule change. Upon action by the BOD, the Rules
Director will inform the initiator of the BOD's decision, and if necessary,
notify the membership as to the new or revised rule. (Adopted by B.O.D. on Nov. 22, 1997)
ICORE
Attn: Rules
Director
P.O. Box 6898
Los Osos, CA 93412
CLOSING REMARKS
The sport of
firearm competition is a challenging arena in which different skills may be
acquired and honed. Each member is responsible for their own behavior and
should contribute to the general safety and enjoyment of other shooters. The
intent of this handbook, as stated at the beginning, is to provide a basis for
safety, fairness, and fun in competition. As a member of ICORE your intent
should be the same. We want to encourage people to remain in the sport. We want
to interest others in joining the game.
As always - DVC to you and yours.
I.C.O.R.E. Rule Modification Proposal Form
Rule
Number : _______________ Proposal No. ______________________
Date
Proposal Sent to Rules Director: ________________
Initiated
By: ______________ Member # __________ Phone: ______________
Email:
__________________________________________________________
|
The rule currently reads: Undesired Effect: |
|
Proposed solution. Modify the rule to read: Desired Effect: |
|
For
Board Use Returned
to Initiator: ___YES ___NO Date ______________ Submitted
to BOD: ___YES ___NO Date ____________ Accepted:
___YES ___NO Date ____________ Modified/Amended:
___YES ___NO Date ____________ Effective
Date: _____________ Comments: Name:
______________________________ |