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Training Design Where Outcomes Come First

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Course Registration

Training Registration Form

DIsclaimer:Required fields indicated with a red astrix.

Have you ever been convicted of a felony crime? *

YesNo

Are you legally disqualified to handle or use firearms due to a court restraining order? *

YesNo

First Name *

Middle Name/Initial

Last Name *

Street Address *Enter number & street

City *

State/Province *

ZIP / Postal Code *

Date of Birth *Enter today's date0 / 10

Primary Phone *ENter the best number to contact you.

Email Address *Providing this iinformation will sign you up for our email communications. If you do not use email you may opt out by stating "No Email"

I'm Registration for... *NRA Basic Pistol - Concealed Carry CertificateDefensive Pistol I - Personal Protection INSIDE the HomeDefensive Pistol II - Personal Protection OUTSIDE the HomeSituational Awareness/Refuse To Be A Victim1st SHots - Pistol/RIfle/ShotgunIntroduction to Firearms - Ladies OnlySelect the class you are registrating for. Individual classes require individual registration.

Course Date *Enter date of class you are registering for

Firearms Experience? Select a rating for your level of experience from 1 to 5. *12345Scale: "1" being a complete novice, to "5" representing you are a seasoned sharp shooter.

Payment Instructions

Signature & agreement *

SIgned & agreed toSignature & agreement

Date *Enter today's date0 / 10

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Directions

Classroom sessions are held at the
Providence Forge Recreation Center
9900 Carriage Rd.
Providence Forge, VA. 23140

Range sessions are held at our private range:
The Sanctuary Range
6341 Courthouse Rd
Providence Forge, VA. 23140
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Payment Portal

CLICK HERE to be taken to our Payment Page.

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