Gift Cert Registration

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Shaded Fields Are Required
GIFT CERTIFICATE NUMBER   (Submit this form only if you have received a Gift Certificate.)
Desired Class Date:
*First Name:
*Middle Name: (If no middle name, enter "NONE")
*Last Name:
*Generation  (Jr., II, etc....  Or, enter "NONE")
     Nickname  (If no nickname, leave blank)
*Address:
*City:
*State:
*ZIP:

*should be the same as Drivers License or State ID

 
Phone: (include area code)
Alt. phone: (include area code)
Ext:
Email
    (Your email address will be added to our free Newsletter list.  You may opt-out at any time):
Date of birth:
Form of identification:

Issuing state:

DL or ID number:
Would you like to qualify with one of our handguns? (semi-automatic only)  

Participation in our CHL Class will require that you sign a Hold Harmless Agreement that will be provided to you on the day of the class.

If you wish to review the terms and conditions of the Agreement Click Here.


By submitting this form, I acknowledge that I have read and accept the terms and conditions of the Staying Alive, Inc., Cancellation and Re-scheduling policies.


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