NRA Training Counselor Course Registration Form

This is an application to attend the NRA Training Counselor Course.

Please enter the desired location in the Notes field below.

Course fee is normally $270 - the TCWS scheduled for Jan, '05 in Seattle is $150.

Please fill out the application below.

Instructor Name:
Instructor ID Number:
Email:
Mailing Address:
City:
State:	AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
Zip:
Daytime Phone:
Evening Phone:

Disciplines You are Certified To Teach
Number of NRA Basic Firearm Training Courses held/students trained during the past two years:
(Example: two rifle courses with a total of 17 students would be "Rifle 2/17")

Rifle Pistol Shotgun

FIRST Steps Rifle FIRST Steps Pistol FIRST Steps Shotgun

Muzzleloading Rifle Muzzleloading Pistol Muzzleloading Shotgun

Training Counselor Personal Protection Home Firearm Safety

Reloading Metallic Cartridges Reloading Shotgun Cartridges Range Safety Officer

Were you the chief instructor for any of the above courses? No Yes
If yes, how many?
Date of last NRA Basic Firearm Training Course you taught:
Comments?