Basic Firearms Safety class – Nation’s Gun Show, Chantilly, Virginia

Student Registration

1. 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: Saturday, October 2, 2010 12 noon - 5pm Sunday, October 3, 2010 12 noon - 5pm (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. 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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