First Name: *		Mailing Address: *		Home Phone: *
Middle Name:		City: *		Work Phone: *
Last Name: *		State: *		Fax:
LEA Agency/Military Unit		Zip Code: *		Email Address: *
Rank:				Confirm Email: *

Requested Course (Tuition Must be Paid in Full with Registration) * Select a Course Tennessee Handgun Permit Course (NRA) Tactical Pistol Instructor Course NRA Range Safety Officer Certification Tennessee Advanced Handgun Non-Lethal Defensive Tactics Concealed Carry Instructor Workshop Executive Protection Advanced Executive Protection Active Shooter

Course Date: (MM/DD/YYYY) * / /

Student Signature: (Print your full name) *

Date: *