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Course you wish to attend:	July 24th, 2010 CHL Class 7:30am to 6pm Aug. 21st, 2010 CHL Class 7:30am to 6pm Sept. 11th, 2010 CHL Class 7:30am to 6pm
Choose type of course:	CHL (10 hours) Cost $100 CHL (Requalification) (4 hours) Cost $75
First Name
Last Name
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Age
Email Address
Drivers License #
Address
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Emergency Contact Name:
Emergency Contact Phone Number:
Firearms Information:
Do you own your own handgun?	Yes No
If yes, what make/model/caliber?
If no, do you need a handgun provided to you to qualify?	No Yes
Do you have any physical limitations, injuries, mental defects, or limitations whether physical or mental which would prohibit you from successfully completing this course or from safely firing a handgun?
No
Yes
If yes explain
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