LEOSA Qualification Registration Form
Please complete this form to register for your LEOSA qualification. I will send a confirmation email with qualification details (specific range address, etc.). If you have not received a confirmation email within 24 hours, please check your spam folder. If it is not there, please call or text me. If it is within 48 hours of your desired qualification date, you may also call or text me at (916) 718-0976. Course fees include the range fee, target, and credit card processing fees. If you have any questions or are experiencing difficulty with this form, please email or call me at (916) 718-0976.
Your name as you want it on your LEOSA qualification card.
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First Name
Middle Name or initial
Last Name
Suffix
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Is it okay to send text messages to this phone number?
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Yes
No
Are you a returning customer?
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Yes
No
Please list the agency you retired or separated from. If a local agency, please list the state as well.
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Date of Birth
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Enter as MM/DD/YYYY
Please select the appropriate qualification date.
Please Select
March 8, 2025
March 9, 2025
March 13, 2025 (NOTE: minimum enrollment applies)
March 15, 2025
March 16, 2025
March 28, 2025 (NOTE: minimum enrollment applies)
April 9, 2025 (NOTE: minimum enrollment applies)
April 12, 2025
April 13, 2025
April 18, 2025
April 19, 2025
Do you need any special learning accommodations? If so, please explain below.
How did you hear about Basic Firearms Training
I am legally allowed to possess firearms and ammunition in the State of California.
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Yes
No
I am an honorably retired or separated law enforcement officer and I meet the LEOSA eligibility requirements under H.R. 218. I understand it is my responsibility to ensure I am eligible for LEOSA and that I understand the rules, regulations, and laws related to carrying a firearm under H.R. 218.
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Yes
No
Please select your appropriate qualification(s) and enter your credit card information. All fees include the range fee, target, and credit card processing fees.
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LEOSA Qualification
H.R. 218 - LEOSA qualification
$
85.00
Private LEOSA Qualification
Private H.R. 218 - LEOSA qualification. PLEASE CALL TO SCHEDULE BEFORE PAYING FOR A PRIVATE QUALIFICATION.
$
170.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Submit Registration Form & Payment
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