Online Registration    

Course you wish to attend:	July 10th, 2010 @ 8626 Tesoro Dr. #504 Aug. 7th, 2010 @ 8626 Tesoro Dr. #504 Sept. 18th, 2010 @ 8626 Tesoro Dr. #504
Choose type of course:	CHL (10 hours) Cost $95 CHL (Requalification) (4 hours) Cost $65 Active Military CHL (10 Hours) $65 Basic Firearms Course (1 1/2 to 2 hours) $60 GIFT CERTIFICATE
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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