Full Registration Form Phone Fill out the form below to finalize your registration. You will be contacted with billing information after we receive your final registration Full Name * Your full name as you would like it to appear on your certificate. Name you go by The name you normally go by, if different from above. Sex * Male Female Date of Birth * Email * Phone Number * A phone number where I can reach you. Mailing Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Emergency Contact Name * This should be a person who won't be at class with you. Emergency Contact Phone * A phone number where I can reach your emergency contact while you're at class. Medical Conditions Please let us know about any medical conditions we should be aware of. Weapons Used * What gun(s) do you plan to shoot in class? Job/Career * What do you do for a living? Past Shooting Experience * What sort of past training or experience do you have with guns/shooting? Rental Gun * Yes No Do you need to rent a gun and gear? Payment * Pay in Full 50% Deposit Will you pay in full or pay the 50% deposit? I have read and agree to abide by Appalachian Tactical Academy, LLC's Rules & Procedures.* Agreement I agree to the Rules & Procedures
