Course Name ___________________________ Course Date ____________Current Date ______________
City ________________________________________ State __________ Zip Code ______________________
Email __________________________________ Primary Phone #_____________________________________
Occupation _________________________________ Employer ______________________________________
Date of Birth ___________________________ Place of Birth________________________________________
Primary Defense Firearm: Make _____________________ Model ________________ Caliber _____________
Prior Training: _____________________________________________________________________________
Emergency Contact Name_______________________Emergency Contact #____________________________
Required documents at time of registration:
Copy of US Driver’s License or US Government Photo I.D.
If Civilian, a copy of current Concealed Weapons permit /or a statement of NO Criminal History from a Law Enforcement
Agency on Official Agency Letterhead
Copy of current active duty, reserve, MIL/LE ID card (if applicable)
In accordance with ITAR regulations, only US Citizens are accepted to participate in Defensive Tactics & Firearms Training courses.
By submitting this application, I understand and agree:
That I must positively identify myself as the same person certified in the credentials for enrollment.
That Defensive Tactics & Firearms Training depends upon careful, physical self-control, including deadly weapons handling and
manipulation by participants, therefore I understand that my participation may be terminated at any time during the course if my
conduct is not deemed satisfactory at the discretion of the instructor.
That I will abide meticulously by any and all safety procedures required at training and that I agree to sign a statement releasing
Special Response Training, Inc. from any liability for any injury I may sustain during the training program.
PAYMENT: Amount__________ Full Tuition is Enclosed
Make check payable to: Special Response Training, Inc.
By submitting this application, documentation, and payment to register, I agree to the terms and conditions outlined in
the application and course description.
Special Response Training, Inc. reserves the right to refuse services to anyone at the discretion of the instructor.
LAW OFFICES OF XYZ
Your firm’s tagline goes here.
|DEFENSIVE TACTICS & FIREARMS TRAINING
|Click on PDF Link
|Special Response Training
|1. Click on PDF and Print Application
2. Complete Application
3. Scan and Attach Completed Application And All Documentation (i.e. Copy of
Drivers License, Gun Permit, L.E. ID) to email.
4. Email the Above Information to email@example.com.
5. Complete course payment process by using the Purchase Course drop down box
below. Click on the appropriate course and click on "Buy Now" button. Choose
payment option and follow the instructions to complete your purchase.
6. Please see option at checkout to use credit/debit card payment if you do not have a
7. Contact Us by Telephone at 706-273-6032 with any questions or to arrange other
methods of payment. By submitting application, documentation, and payment, you
agree to the terms and conditions outlined in the course description and application.