Individual Registration

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    Shaded Fields Are Required 

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:

*must 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 News Letter 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 LTC 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.


How did you hear about us?

 

Name:


PAYMENT INFORMATION

Promo Code: 


Credit card Information:

Billing Amount:
Texas License To Carry Class $125.00
Military
 
(Must be on Active Duty status, on date of class)
$75.00
Card Issuer:
Card Number:
Expiration Date:
Card Verification Number:  (3 digit number printed on back of card - If un-readable, enter "NONE")
Name on Card:
Billing Address:
Street or PO Box City State ZIP

CLICK HERE for an explanation of our Cancellation and Re-scheduling Policies.


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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