Standby Request

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To have your name placed on a standby list for our next open enrollment class, please complete this form.  You will be notified when we schedule a class.  Completing this form does NOT obligate you to take a class.  

 

Shaded Fields Are Required
*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 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 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:


Click Here for an explanation of our Cancellation and Re-scheduling Policies.


If you are human, complete the following:  5  +     =  7

Please understand that by submitting this form, you incur no obligation to accept a seat in  a future class.  Nor, does it obligate Staying Alive, Inc., to accept a complete registration for a future class.


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