Online Registration    

Course you wish to attend:	OCTOBER 2008 CLASS : Oct. 11, 2008 (9am to 8pm) @ Bass Pro Shops NOVEMBER 2008 CLASS Nov. 15, 2008 (9am to 8pm) @ Bass Pro Shops DECEMBER 2008 CLASS Dec. 13th (9am to 8pm) @ Bass Pro Shops
Choose type of course:	CHL (10 hours) Cost $90 CHL (Requalification) (4 hours) Cost $65 Active Military CHL (10 Hours) $60 Basic Firearms Course (1 1/2 to 2 hours) $50
First Name
Last Name
Middle Initial
Age
Email Address
Drivers License #
Address
City
State
Zip
Phone
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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