Larry Church's
Utah CCW Training Class
Enrollment Form

This is your class Enrollment Request Form


 FIELDS MARKED WITH * ARE REQUIRED!

 Class Date:*          January 23, 2010 (Saturday, Noon - 4:00 pm)

 Your Name:*          

 StreetAddress:*      

 StreetAddress2:      

 City:*               

 State:*              

 Zip:                 

 E-Mail Address:*     

 Contact Phone:       

 Name to be           
 used in class:

 Handgun Make/Model:   /  

 Handgun caliber:     

 Any questions?       

 How did you find us: 

 Add to Mailing List: Yes
                      No

 When done, please  or