We need to know a little about you so we can contact you about our courses.      

Course Information

At a minimum we need a name and an address (email or mailing).

Date: ___________________                                         

Preferred location:

           Durango            Pagosa Springs             Either                  Other_____

 Name:___________________________________________________________

Address1:________________________________________________________

Address2:________________________________________________________

City _______________________ State_____________ Zip: ________________

 Email   _____________________________    Gender  ________   Age _______

 Day phone: __________________________

 Night phone: _________________________

 Reasons for taking course:     Curious                 CCW-New         CCW-Renew

   (Circle all that apply)              Safety                    Other  __________________

 How did you learn of us?        Newspaper           Sheriff                Gun Shop __________

   (Circle all that apply)             Friend                   NRA                   Durango Gun Club

                                                   Other  ____________________________________

Briefly describe prior shooting experience, especially previous courses,

military experience, competitions, etc.

Comments: