Virginia Pistol Registration Form
To enroll in a Virginia Pistol class the following form must be completed.
Course Name:____________________________________________________________________________
Class Date(s):________________________ Location:____________________________________
Your FULL Name: _______________________________________________________________
Address: ___________________________________________City: __________________ State: ___ Zip: __________
Home Phone: _______________________ Work Phone: _______________________________
Cell Phone: __________________________E-Mail: _____________________________________
Handgun/Firearm Experience? _______________________________________________________________________
Your Height: __________ Weight:___________ DOB: ___________Age: _______ Sex: _______
NRA Member, YES: _____ NRA Mem. Num.: __________________ NO: _______
I learned about this course from: _____________________________________________________
Remarks:________________________________________________________________________________________
Why are you taking this course? _____________________________________________________________________
Are you seeking to apply for a Virginia Concealed Carry License? ______________
Do you currently own a handgun? ___________________ Last time you fired it? _____________________________
If you own a handgun you plan on using in this course, what is the make, model, caliber and age of the gun:
______________________________________________________________________________________________
If you do not own a handgun what type of shooting are you preparing for?
Target____________ Hunting _______________ Personal Protection ___________________
Please mail this form, and if you did not pay a deposit online, include appropriate depsit amount, and mail to:
Virginia Pistol, LLC
5267 John Marshall Highway Suite G
Linden, VA 22642
I understand and agree that my enrollment fee is non-refundable and that if I can not attend this course I will be rescheduled for the same course at a future date. I have read the Virginia Pistol Waiver Form and agree to sign the waiver form when I attend the course before any instruction takes place. I understand that I must have a photo ID in my possession when arriving for the first day of class, and if I don not have it I may not be allowed to take the class.
___________________________________________/ _______________________________________/___________
Signature,Printed Name,Date