Date and Class Title	--- Select one of the following --- Put me on your mailing list
Name on driver's license
Address
City
State	Zip
Birth Date	(m/d/yyyy)       Passcode
E-Mail Address
Phone Number
Firearm's Experience	Beginner   Novice   Intermediate   Advanced

Rounds fired in last 3 months

Firearm's Org/Mbr#

Comments/Concerns