Basic Marksmanship Instruction Registration Form

Please complete the form, below. After submitting you will be contacted for your social security number and payment arrangements. You will be required to sign the completed form on the day of class.

First Name*

Middle Initial

Last Name*

Address

City

State

Zipcode

Phone*

Email*

Birthdate

Select a class

Possess a valid and current LTC or FID?*

Yes No

Own a firearm?*

Yes No

If Yes- what model & caliber?

Please Read Carefully Before Signing

I understand by signing this form this gives WESTERN MASS SELF DEFENSE the right to accept or deny my application should any information be intentionally left out or misleading. I further understand that WESTERN MASS SELF DEFENSE is not held responsible for any equipment that may be lost, stolen, or broken; or any injuries that may be sustained during training. I also understand that I am not entitled a refund should I not act or conduct myself in a unsafe manner as to cause injury to myself or any other participants. I understand this will be definite grounds for dismissal with prejudice.

Your Tuesday Color*

Please review what you entered before you click the Submit button, and click it ONLY ONCE.

Basic Marksmanship Instruction Registration Form

Please Read Carefully Before Signing

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