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Concealed Carry Registration Form

March 20, 2019

I understand that this is not a beginner's shooting class. I understand that I must be fully able to operate the firearm I intend to qualify with. I understand that this includes loading magazines, racking the slide, and any and all other operations required to shoot for qualifications. I understand that there will be no exceptions to this rule.

I Agree

 

I understand that I will be asked to leave the range and will forefit my application fee for any violation of range rules or unsafe firearm handling.

I Agree

 

I understand that class tuition is non-refundable.

I Agree

 

I swear and attest that I am not a New Mexico DPS Concealed Carry Class monitor or auditor

I Agree

 

I affirm that I am not a felon and that I meet all the requirements for application and possession of a New Mexico concealed carry permit or a firearm.

I Agree

 

First Applicant Name

First Name*

Middle Name

Last Name*

Phone*
First Applicant Date of Birth*
First Applicant Signature*
Second Applicant Name

First Name*

Middle Name

Last Name*
Second Applicant Date of Birth*
Third Applicant Name

First Name*

Middle Name

Last Name*
Third Applicant Date of Birth*
Fourth Applicant Name

First Name*

Middle Name

Last Name*
Fourth Applicant Date of Birth*
Fifth Applicant Name

First Name*

Middle Name

Last Name*
Fifth Applicant Date of Birth*
Sixth Applicant Name

First Name*

Middle Name

Last Name*
Sixth Applicant Date of Birth*
Seventh Applicant Name

First Name*

Middle Name

Last Name*
Seventh Applicant Date of Birth*
Eighth Applicant Name

First Name*

Middle Name

Last Name*
Eighth Applicant Date of Birth*
Ninth Applicant Name

First Name*

Middle Name

Last Name*
Ninth Applicant Date of Birth*
Tenth Applicant Name

First Name*

Middle Name

Last Name*
Tenth Applicant Date of Birth*
Applicant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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