NRA FIREARMS TRAINING REGISTRATION

"*" indicates required fields

Full Name*

First Name Middle Initial Last Name

Address*

Street Address Address Line 2 City State ZIP Code

YOUR HOME ADDRESS INFORMATION

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

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

This is on your AGC range badge.

Email Address*

The email address for Club email notices & information.

Phone Number*

The best phone number to call you.

Check the NRA Course you are registering for:*

NRA Home Firearm Safety

NRA Basic Pistol Course

NRA Concealed Carry Course

NRA Basic Rifle Course

NRA Basic Shotgun Course

NRA Personal Protection INSIDE the Home

NRA Refuse To Be A Victim

Check any other firearms Training Courses successfully completed:*

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.

Briefly describe you level of experience with firearms.*

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