CCWOFNC Registration Form
Name:________________________________________
                       Last               First               Middle (Full)
Address:________________________________________
City:____________________    State: NC  Zip: _________   
DOB:_______________

Phone:_______________ Email:_________________
Event Requested (circle): NC Conceal Carry Permit ( $120.00) Sat 1/9/16   Sat 1/30/16   Sat 2/13/16  
Sat 3/12/16
Shotgundamentals Sun 1/17/16 2P-5P $50.00

Course Date Requested:____________________________
Disclaimer!
I understand that the use of firearms is inherently dangerous and that any unsafe use of them could result in death or serious bodily harm. As a prerequisite to enrollment, I agree to follow all safety rules set forth by my Instructor and that my willful disregard of them will result in my dismissal from class, without reimbursement of my tuition. I will not use drugs or alcohol preceding or during class. I further agree to hold CCGCI Inc & CSA LLAC harmless for any accidents or injuries which may occur while in class or at the range. I agree to report any safety violations that I may witness to my Instructor immediately so that we can take immediate action to insure the safety of other students.*I affirm that I possess fundamental firearms knowledge regarding safe handling, storage & cleaning prior to attending this class.*
Please Do NOT Bring Your Firearm Into Class.
Please Leave Locked In Car Until Qualifying.
(   )INITIAL here to indicate Disclaimer has been Read, Understood and Agreed.
Preregistration & Prepayment Required.No Refunds.
Payment Methods: Cash, Money Order, CC's via PayPal
Email: info@ccwofnc.com
Questions: 336.270.9CCW (9229)
Mail To: CCWOFNC
1964 Stoney Creek Church Road
Burlington NC 27217
The 2nd Amednment