Name *

Please print name as you would like it printed on your certificate.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am legally allowed to possess a firearm *

I am legally allowed to possess a firearm.

I am Not legally allowed to possess a firearm

Additional Training Interests

Ladies Only Shooting Clinic

Family Shooting Clinic

Women On Target Clinic

Refuse to be a Victim

New Shooter Orientation

Home Firearm Safety

Basic Pistol

Personal Protection Inside the Home

Personal Protection Outside the Home

Defensive Pistol

NRA CCW

Instructor Development

I understand that the course deposit is non refundable. I am able to transfer this fee ONE TIME as long as I've contacted the instructor 48 hours in advance of the course if I cannot make the class *

I Understand

I understand that this course may be postponed or rescheduled due to weather or range needs *

YES I understand

I understand that the instructor is holding a spot in the course for me, and that I forfeit my deposit if I do not show up for the course *

YES I understand

I have read the course requirements ( If any ) and I qualify for the course. I understand what I need to bring to the class *

I understand

I do not understand and will contact the instructor with questions at highmark44@gmail.com

I WILL be renting a gun from the instructor *

YES

NO

IF I am renting a firearm, I understand that I must provide good quality factory ammunition *

I Understand

Not applicable, I'm bringing my own gun and factory ammo (NO reloaded ammunition)

I am renting a firearm, and understand the rental fee of $20 for the course will apply. *Except for Women on Target & Family Clinics

YES I understand