MARYLAND HANDGUN QUALIFICATION LICENSE (HQL) TRAINING COURSE REGISTRATION

"*" indicates required fields

NOTICE: COMPLETION OF THIS FORM DOES NOT GUARANTEE YOUR ACCEPTANCE AS A STUDENT NOR DOES IT GUARANTEE YOU WILL RECEIVE AN HQL CERTIFICATE FROM THE MARYLAND STATE POLICE.

Please do not leave any fields blank - insert "none" if no data applies.

Full Name*

First Name Middle Initial Last Name

Address*

Street Address Address Line 2 City State ZIP Code

Gun Club affiliation: ("none" if no club affiliation)

AGC Range Badge Number ("none" if you do not have an AGC range badge)*

Email Address*

Phone Number*

The best phone number to call you.

Student Background Information:

Check any other firearms Training Courses successfully completed:*

NRA Home Firearm Safety

NRA Basic Pistol Course

NRA Basic Rifle Course

NRA Basic Shotgun Course

NRA Personal Protection INSIDE the Home

NRA Personal Protection OUTSIDE the Home

NRA Range Safety Officer

None

Do you currently own a handgun?*

Yes

No

Type of handgun(s) you currently own:*

Revolver

Semi-automatic

Other

I don't currently own a handgun.

Caliber(s) of the firearm(s) you currently own (or none)?*

i.e. .38 / .357 / 9mm / .40 / .45

What type of handgun you are planning to purchase?*

Revolver

Semi-automatic

Undecided

Other

Caliber of the firearm(s) you are planning to purchase?*

i.e. .38 / .357 / 9mm / .40 / .45

Emergency Contact Information:

Name of your Emergency Contact*

Name of the person to contact in an emergency.

Phone number of your emergency contact.*

Primary phone number to call in an emergency.

Alternate phone number of emergency contact (if applicable, otherwise insert "none")

Secondary phone number to call in an emergency.

Relationship of your Emergency Contact to you.*

The relationship of your emergency contact person to you.

More about you:

Do you have any physical limitations we need to know about to accommodate your training needs?*

Briefly describe you level of experience with firearms.*

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