Registration

Name *

First

Last

Home Address, City, State, ZIP *

Phone Number *

Cellular Phone Number *

Email *

Date of Birth *

Driver's License Number *

CA POST ID Number

Agency or Military Unit (If taking a LE/MIL Only course)

Emergency Contact Person (Name, Phone, Relationship) *

Course Title you are signing up for (Defensive Handgun, Advanced Carbine, etc.) *

Firearm you will be utilizing, Make, Model, Caliber (example: Glock 19, 9mm) *

Previous Firearms Training (If yes, complete box below) *

Name of prior firearms training course (facility/company/instructor name, etc.) If active LEO, put agency name only.

Length (hrs) of firearm training course (from above)

Are you a U.S. Citizen *

Do you have any Felony criminal convictions and/or any Domestic Violence Misdemeanor criminal convictions *

Are you prohibited by any Local, State or Federal Law from Possessing a Firearm *

Are you the Respondent or Subject of a Domestic Violence Restraining Order *

Have you ever been adjudicated as mentally ill or have you ever been committed to any mental health facility *

Are you currently taking any medication or substance that will impair your physical ability, judgement or decision-making. *

By submitting this application, I have read, understand and agree to the following (Read Below):