Course Registration Form
All below payments are deposits only where noted!
If you are redeeming a GIFT CERTIFICATE you must
call 610-509-1569 to register for a class.
Student Name
*
First Name
Middle Name (Optional)
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
example@example.com
Phone Number
*
Will you need to rent a firearm? Fee $25.00 (CONCEALED CARRY COURSE ONLY
*
Please Select
NOT APPLICABLE (NON FIREARM CLASS)
Yes I will need to rent a firearm
I have a firearm to bring with me
If renting a firearm you must bring your own 22 Long Rifle ammunition. A minimum of 50 rounds required.
Experience Level?
*
Please Select
NOT APPLICABLE (NON FIREARM CLASS)
No I am a new shooter
More Experienced
This helps us to provide you with the proper support when at the range shooting.
Course Date Requested
*
-
Month
-
Day
Year
Please verify for accuracy
How did you hear about our classes?
*
Please Select
Previously took a course
Morning Call
Event
Face Book
Instagram
Google
Xtreme Gun Worx in Emmaus
Boyers Hardware in Slatington
NJT ARMS
Guthsville Rod and Gun Club Orientation
Instructor Tim Knopf Referral
Instructor Carmine Pellosie Referral
Previous Student Referral
Are you a current member of Guthsville Rod and Gun Club?
*
Please Select
Yes
No
Membership is NOT required to take course
Submit
My Products
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Women’s Basic Handgun (Deposit) Full price $175
$
100.00
Concealed Carry and Home Defense(Deposit) Full price $175
$
100.00
Defensive Handgun Level I (Total Fee)
$
200.00
Defensive Hangun Level II (Total Fee)
Prerequisite Defensive Handgun Level II
$
200.00
Defensive Handgun Level III (Total Fee)
Prerequisite Defensive Handgun Level I and II
$
200.00
Steel-Defensive Challenge (Deposit) Full price $95
$
45.00
AR-15 Fundamentals Level I (Total Fee)
$
200.00
Unarmed Defense Tactics (Deposit) Full price $120
$
50.00
Emergency First Aid Fundamentals (Total Fee)
$
120.00
Realtor Safety & Self-Defense (Total Fee)
$
120.00
AR-15 Tactical Course Level II (Total Fee)
$
200.00
New Jersey CCW Certification Deposit Full price $225.00
$
100.00
Utah Permit (Total Price)
$
130.00
Credit Card
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