Course Title & Date: Defensive Handgun @ RVSSA in White City, OR- March 15 & 16, 2003

You full name as you would like it to appear on a Graduation Certificate:

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Your first name as you'd like it to appear on a name badge: ______________________________

Home Address: ________________________________________________________________

City: ________________________________State_____________________ZIP_____________

Day Phone: _____________________________ Evening Phone: _________________________

E-mail: __________________________________

Briefly list previous firearms training (use back if necessary): _______________________________

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Are you a Law Enforcement Officer/ Armed Private Security Officer? Y / N
(If yes, please submit a photocopy of your DPSST ID card)

Do you have a current Concealed Handgun License? Y / N
(If yes, please submit a photocopy of your license. If no, then read below for further instructions)

Participant's Signature:

_________________________________________ Date: ______________________________

Important Note: Oregon Firearms Academy LLC is a small business, which purposely keeps classes small for the benefit of our students, full tuition of $200 per student is required in order to secure a space as a student at this course.

Documentation Requirements: Oregon Firearms Academy LLC requires each student to photocopy and submit with their registration a valid State Issued Concealed Handgun Permit/License, Law Enforcement or DPSST Armed Security Identification for this courses. Please understand that due to the nature of the material presented, it is necessary to limit instruction to those individuals who can be entrusted with police-based defensive firearms instruction. If you do not have a current issued CHL, we will accept a police background check, or a letter on official letterhead from a Law Enforcement Agency, or from an Attorney, DA, or Judge attesting that you have no felony record, mental history, or any background that would prevent you from owning or possessing a firearm. If you have any questions about this, please call or e-mail us.

Cancellation Policy: If for any reason you are unable to attend class you will receive a full refund if you cancel within 14 days prior to the scheduled class. Please call the office to cancel. If however, you do not attend or you cancel less than 14 days prior to the scheduled class 50% of your tuition is nonrefundable. All checks returned due to NSF will be assessed a $25 service fee.