Enrolment Form

PROGRAM NUMBER : Program 1. Revolver or Pistol Only ($350)
Program 2. Revolver and Pistol Combined ($400)
Program 3. Revolver, Pistol and Shotgun ($450)

COURSE DATES YOU WOULD LIKE TO ATTEND : eg. June 17-24

HOW DID YOU HERE ABOUT US ?

FULL NAME :

DATE OF BIRTH :

MOBILE PHONE NUMBER :

EMAIL ADDRESS :

SECURITY LICENCE NUMBER :

HANDGUN LICENCE NUMBER :

LONGARMS LICENCE NUMBER :

RE-QUALIFICATION COURSE : PROGRAM 1. - Revolver / Pistol Only ($350.00)

EQUIPMENT REQUIREMENTS : I require the use of a firearm and holster.
I will supply my own firearm and holster.

PAYMENT METHOD : Cash (In person)
Eftpos (in person)
Credit Card (go to bottom of page)
Other : Please contact CODE ONE.

TRUE AND CORRECT : I (named above) confirm all information is true and correct

FIREARM RE-QUALIFICATION ENROLMENT FORM :

PERSONAL INFORMATION :

PAYMENT OPTIONS :

ACKNOWLEDGEMENT :