MARYLAND WEAR & CARRY PERMIT TRAINING REGISTRATION

"*" indicates required fields

NOTICE:

MT. WASHINGTON RESERVES THE RIGHT TO DENY TRAINING TO ANY INDIVIDUAL WHO DEMONSTRATES UNSAFE BEHAVIOR OR PRESENTS AN ATTITUDE WHICH IS NOT CONDUCIVE TO A SAFE AND PRODUCTIVE TRAINING ENVIRONMENT.

IN ALL CASES, THE COURSE INSTRUCTOR HAS TO SOLE AUTHORITY TO REMOVE ANY STUDENT WHO IN THE INSTRUCTOR'S PROFESSIONAL OPINION PRESENTS A DANGER TO HIMSELF/HERSELF OR OTHERS.

COURSE FEES ARE REFUNDABLE ONLY AT THE DESCRETION OF THE CLUB.

COMPLETION OF THIS FORM DOES NOT GUARANTEE ACCEPTANCE AS A STUDENT NOR DOES IT GUARANTEE YOU WILL RECEIVE A MARYLAND PERMIT TO WEAR & CARRY A HANDGUN 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*

Training Course: (Select one course only)

Check any other firearms Training Courses successfully completed:*

Do you have a Maryland Handgun Qualification License (HQL)?*

Yes

No

Expired

Do you have a valid Maryland Handgun Wear & Carry Permit?*

Yes

No

Do you currently own the firearm you will routinely carry?*

Yes

No

Undecided on which firearm I will carry.

If "Yes" to question above, which type of firearm will you carry?*

Revolver

Semi-automatic

Both, depending upon the circumstances.

Caliber(s) of the firearm(s) you intend to carry?*

.22

.380

9mm

.38 Special

.357 Magnum

.357 SIG

.40 S&W

.45 ACP

Other

Are you right handed or left handed?*

Right handed

Left handed

Ambidextrous

Are you right or left eye dominate?*

Right eye

Left eye

Don't know which eye is dominate.

Emergency Contact Information

Name of your Emergency Contact*

Phone number of your emergency contact.*

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

Relationship of your Emergency Contact to you.*

List/describe any medical conditions you have which may compromise your ability to safely participate in this course.*

Previous Firearms Experience and/or other training not listed above.

Briefly describe you level of experience with firearms.*

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