Registration
PSA Training Registration Form
Submission Date: __________________
Course Dates: __________________
Course Title: ________________________________________________________________________________________________________________________________
Name:_________________________________________________________________________________________________________________________________________
Address:_______________________________________________________________________________________________________________________________________
City: __________________________________________________________________________________________________________________________________________
State: ______________ Zip Code: ________________
Identification: (Send Copy of State Driver’s License or Valid ID:) __________
Phone: (home): ______________________________
(Work): _______________________________
Fax: _______________________________
E-mail (Primary): __________________________________
E mail: (Secondary): ___________________________________
Please give a brief description of your experience in the use of firearms:
Are you a beginner/novice, recreational shooter, competitive shooter, or have law enforcement/military experience? (use another page if necessary
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________
Do you have any prior or pending criminal action against you? If yes, please explain: use another page if necessary).
____________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________
Please check one and provide information as requested:
I have enclosed evidence of absence of criminal history from a local law enforcement agency on official department letterhead: _____
I have enclosed evidence of current, active, full time service with a public law enforcement agency or the United States Armed Forces: _____
I have enclosed a copy of my I.D. or other appropriate credentials: _____
A copy of a current concealed carry permit. _____
Signature: _______________________________________________
Date: ____________________
Send Registration To:
The Practical Shooting Academy, Inc. P.O. Box 630 Olathe, CO 81425Contact Information: Phone: 970-323-6111 – Email: PSARON1@aol.com
Please Note:
- Reserve Officers attending LE Only courses must have written recommendation from the appropriate agency head.
- You are not registered for the course unless you are paid in full or have made arrangements for payment with The Practical Shooting Academy, Inc.