CCW USA FIREARMS TRAINING
REGISTRATION FORM
To Register for a Utah and Florida CCW Permit Class
please complete the class application form below, PRINT AND FAX to 619-923-9500. You will receive a confirmation email once
your application is approved. You must receive a confirmation email to verify that we have received and approved your application
and your space has been reserved.
Name:(F)_______________________________
(L)_______________________________(MI)__
Street
Address:_________________________________________________________________________
City/State/Zip:_________________________________Phone:____________________________________
email
address:__________________________________________________________________________
[1] Age:______ (Must be over 21 for CCW Permit)
[2] Which Class Date are you requesting? ________________
[ ] Permit
Class [ ] Tactics Class [ ] Defensive
Handgun Clinic
[3] Which Permit? Utah Permit - Florida Permit - Both Permits (CA Permit see California CCW Page for specific instructions)
[4] Do you have any other Firearm related
permits? (CCW, BSIS Exposed, Hunter Safety Card, etc.)
[5] What is your level of experience with handguns? (NRA Courses, State Firearm Courses, L.E. or Military,
Organized Competition, # years of practice, etc.)
[6] How did you find out about this course? ________________________
[ ]$150.00 CLASS FEE (INCLUDES UTAH AND FLORIDA)
[
]$ 10.00 UTAH PHOTOGRAPH
[ ]$ 20.00 UTAH FINGERPRINTS
[ ]$ 20.00 FLORIDA PACKET W/PHOTOGRAPH
[ ]$ "N/A" FLORIDA FINGERPRINTS Must be taken by a Law Enforcement Agency
[ ]$ 25.00 RANGE QUALIFICATION Required only if you DO NOT have some proof of prior training or experience e.g. L.E., Military, NRA Course,
Hunter Safety, Competition, etc.
PAYMENT OPTIONS: Cash [ ]
Check [ ] Visa [ ]
MasterCard [ ]
Name as it appears on the card_______________________________________
Card Number_____________________________________________________
Exp.- Mo._____Year__________V-Code_______ (3
digits on back of card) Billing Zip code________________
Signature_______________________________Total
Amount $_______________
GENERAL ELIGIBILITY REQUIREMENTS:
Applicant must be at least 21 years of age
Proof of good character... whereas
the applicant; has not been convicted of a felony, or:
Convicted of any crime of violence
Convicted of any offense involving
the use of alcohol (Must be 6 years old for Utah Permit)
Convicted of domestic violence
Convicted of offenses involving
the unlawful use of narcotics or other controlled substances
Convicted of moral turpitude
Convicted of any offense adjudicated
by a court of a state or of the United States as mentally incompetent
A thorough criminal background check is conducted
for all applicants.
I hereby Certify that I understand the above listed requirements and I
have no Felony Convictions, and no Convictions for Misdemeanor crimes that could prohibit me from legally owning or possessing
a firearm. Initial here____________
NOTE: This is a basic lecture course, it does require some basic familiarity with firearms. A basic Defensive
Handgun course is strongly recommended before attending this class. If you have any questions please call or email us today.
www.CCWUSA.com
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