POC Name *

Name of person requesting and organizing the hosting of this course

First Name

Last Name

POC Phone *

Point of contact's phone number

(###)

###

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Who will this course be available to? *

Please select who this course will be open to.

Open to public

Closed course for private group

Open only to Security Guards

Open only to Bail Enforcement Agents

1st Preferred Host Date *

Please give us your preferred date to host the course.

MM

DD

YYYY

2nd Preferred Host Date *

Please give us your 2nd preferred course date, in the event your 1st choice isn't available.

MM

DD

YYYY

3rd Preferred Course Date

Please give us your 3rd preferred date to host the course

MM

DD

YYYY

Training Site Address *

Please give the address of the training site.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Training Site Type *

Please select the training site type that applies.

Commercial Shooting Range

Private Shooting Club

Personally Owned Private Land

Other

Shooting Range Type *

Please select the shooting range type that applies.

Indoor Shooting Range

Outdoor Shooting Range

Contact Name for Training Site

Give the name of the person who owns or manages the training site if someone other than the POC

First Name

Last Name

Training Site Contact's Phone #

Please give the phone # for the training site's contact person if different from the POC

(###)

###

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