LEOSA Qualification Registration Form

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. *

First NameMiddle Name or initialLast NameSuffix
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
YesNo
Please list the agency you retired or separated from. If a local agency, please list the state as well.*
Date of Birth*
Enter as MM/DD/YYYY
Please select the appropriate qualification date.
Do you need any special learning accommodations? If so, please explain below.
How did you hear about Basic Firearms Training
YesNo
YesNo

Please select your appropriate qualification(s) and enter your credit card information. All fees include the range fee, target, and credit card processing fees.*

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

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty: