Student Registration

1. First & Last Name(required)
2. Street Address(required)
3. City(required)
4. State(required)
5. Zip Code(required)
6. Primary Phone(required)
7. Secondary Phone
8. Email(valid email required)
9. How did you hear about Proactive Shooters?(required)

Course Selection

1. Course Date Choose Class Date: Sunday, April 15, 2012 11am - 4pm Saturday, May 5, 2012 11am - 4pm Saturday, June 2, 2012 11am - 4pm Saturday, July 14, 2012 11am - 4pm Saturday, August 4, 2012 11am - 4pm (required)

Person to Notify in Case of Emergency

1. Name(required)
2. Primary Phone(required)
3. Secondary Phone

Safety Class - Certificate of Completion

1. Please indicate how you would like your name to appear on your certificate. Example - John Smith, John J. Smith, John J. Smith Jr.
2. Name(required)
3. Please enter the verification code shown on the right.
4. IMPORTANT - You must click "SUBMIT" to send your registration. You will then be redirected to the "Pay Now" button to make your payment with your Visa, Mastercard, Discover, American Express, electronic check or Paypal account. If you wish to pay in another manner, you may do so by contacting our offices to make arrangements.

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Please Do Not click Pay Now Until AFTER You Submit your form data!