2009 COURSE REGISTRATION FORM

							                                   2009
                                   COURSE REGISTRATION FORM

One registration form is required per student. Please complete and mail to Templar Tactical, Attn: Course Registration, 35934 Hanamar Dr, Avon, OH 44011 or fax
to 1-877-211-5836. All cancelations must be received 20 days prior to course date for a full refund. Any cancellation made within 20 days of course date will receive
a refund of 50% of the cost.

STUDENT INFORMATION
Name (Last, First Middle)                                                                                                              Rank

SSN                                                      DOB                                                         Sex           M          F

Contact Phone Number                                                                 Student Email

Agency

Agency Address

City                                                                                      State                                  Zip

Agency Phone                                                                         Agency Fax

Country of Citizenship                                                               Country of Birth

Emergency Contact Name                                                                            Phone

COURSE AND COSTS
Course Name                                                                                       Course Date

Course Tuition         $

Ammunition provided by Templar Tactical                   Y          N           Cost        $

On-site bunkhouse ($45.00 per night)                 Y         N             Number of Nights                   Bunk House Total       $

BILLING INFORMATION
Name                                                                                 Title

Billing Address

City                                                                                      State                                  Zip

Email Confirmation Address

Do you require an estimate to generate a PO                    Y         N

Payment Method                 Check - (make out to Templar Tactical LLC)                    PO - (PO Number                 )          Credit Card - (See Below)

CREDIT CARD INFORMATION (If paying by credit card)
Type of Card               VISA        MASTERCARD                  DISCOVER             AMERICAN EXPRESS

Credit Card Number                                                           Expiration Date                            Security Number

Name on Card

Card Holder Signature

SIGNATURES
Both the student and Chief, Sheriff, CO or Supervisor must sign for the application to be processed.
Signing below acknowledges that:
     1.    The student is acting as a representative of the agency and this is considered on-duty training with agency sponsorship.
     2.    The student agrees to review and sign a waiver of liability prior to training.
     3.    The student agrees to abide by all safety regulations and facility rules set forth by Templar Tactical.
     4.    The student is aware that any person deemed as unsafe, can/will be asked to cease training and leave the range.
     5.    The student is over the age of 18 prior to the training date and has no felony record.
     6. The student must present a valid military or agency identification card at check in.

Student Signature                                                             Supervisor Signature

Print Name                                                                    Print Name

Date                                                                          Date