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First Name
Last Name
Address 1
Address 2
City
State
Zip
Mobile Number
Home Number
DOB
Email:
Interested in a Concealed Carry Permit?
Yes
No
Class Date
Class Time
Hours
 
 : 
Minutes
 
FOID Card Number
FOID Card Expiration Date
Caliber
Gun Type (if applicable)
NRA Member
YES
NO
NRA Number
Comments
 
Gun and Ammo 
Rental Rate  $30.00