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Please fill in all information listed, failure to complete all sections of this form may result in you being refused admission
to any certified training course. Please ensure all answers are truthful and accurate.
Phone Number _________________________
Name (Last, First Middle): _______________________________________________
Current Address: _____________________ City: _______________ State: _____ Zip: _______
Weapon Make: __________________ Model: ______________ Caliber: ____________
SN____________________________ FOID # ______________ EXP Date: __________
Experience with firearms: ____________________________________________________________________
I wish to enroll in the following class(s)
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