Course Title: ___________________________________ Course Date: __________________________________

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

____________________________________________________________


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

Home Address: _____________________________________________________________________

City: ___________________________________State___________________Zip Code____________

Day Phone: _____________________________ Evening Phone: _______________________________

Email Address if you prefer us to contact you by email: ________________________________________

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

_________________________________________________________________________________

_________________________________________________________________________________

What type of firearm are you bringing to class? Make:__________Model:_______________Caliber:____

Are you a Law Enforcement Officer? Y / N

Do you have a current Concealed Handgun License (CHL)? Y / N -- A current CHL is REQUIRED for all courses except Basic Handgun Safety, OC/Pepper Spray and Armed Security Courses. Please mail or Fax us a photocopy of your CHL to our office BEFORE the start of our course. LEO are not required to submit a CHL but will need to submit a photocopy of their LEO ID.

If so, provide the State of issue and number: _________________________________________

Participant's Signature - NOTE: Your signature on the line provided indicates you have read this Registration form in its entirety acknowledging you can legally own, possess, and train with firearms and you agree to the terms outlined in the cancellation policy written below.

_________________________________________ Date: _____________________________

NOTE: Oregon Firearms Academy LLC is a small business, which purposely keeps classes small for the benefit of our students, therefore, full tuition is required in order to secure a space as a student at this course. The check can be made out to Oregon Firearms Academy LLC P.O. Box 909 Lebanon, OR 97355. WE CAN ACCEPT AGENCY CHECKS OR CREDIT CARDS!

IMPORTANT NOTE: Restrictions: Oregon Firearms Academy LLC reserves the right to limit enrollment to our courses. If you have been convicted of any felony, or any crime which prohibits you from purchasing, owning or possessing a firearm and/or found mentally ill which prohibits you from legally purchasing, owning or possessing a firearm then you are unable to attend any of these courses.

Therefore, Oregon Firearms Academy LLC requires each student to photocopy and submit with their registration a valid State Issued Concealed Handgun Permit/License, Law Enforcement Identification or DPSST Armed Security Identification for all courses except Basic Handgun Safety. Please send a copy for EACH course you sign up for regardless if we have a copy on file or not. 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 Conceal Handgun Permit/License, 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 cannot attend class or need to transfer to another class, you will receive a full refund if you cancel/transfer 10 days prior to the scheduled class. Please call 541-451-5532 in order to cancel or transfer. If you cancel/transfer less than 10 days prior to the scheduled class, 100% of your tuition is nonrefundable. All Guest Instructor courses are nonrefundable. All NSF checks will be charged an additional $25 service fee.