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Course you wish to attend:	April 26, CHL Class 8am to 7 pm May 24, CHL Class 8am to 7pm June 28, CHL Class 8am to 7pm
Choose type of course:	CHL (10 hours) Cost $125 CHL (Requalification) (4 hours) Cost $75
First Name
Last Name
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Age
Email Address
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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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