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Basic Firearms Safety class – Nation’s Gun Show, Chantilly, Virginia
Student Registration
First & Last Name
(required)
Street Address
(required)
City
(required)
State
(required)
Zip Code
(required)
Primary Phone
(required)
Secondary Phone
Email
(valid email required)
How did you hear about Proactive Shooters?
(required)
Course Selection
Course Date
Choose Class Date:
Saturday, February 11, 2012 12 noon - 5pm
Sunday, February 12, 2012 12 noon to 5pm
Saturday, April 21, 2012 12 noon - 5pm
Sunday, April 22, 2012 12 noon - 5pm
Saturday, June 9, 2012 12 noon - 5pm
Sunday, June 10, 2012 12 noon - 5pm
(required)
Person to Notify in Case of Emergency
Name
(required)
Primary Phone
(required)
Secondary Phone
Safety Class - Certificate of Completion
Please indicate how you would like your name to appear on your certificate. Example - John Smith, John J. Smith, John J. Smith Jr.
Name
(required)
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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