Great Plains Rifle LLC :: Registration Form

CCW Training Class Registration Form:

Please fill out and print this Registration Form to send in with your payment.

Class Costs:

Nebraska CCW Class: $110.00

We would like payment prior to class.

Please make check or money order payable to "Great Plains Rifle Works LLC" and mail the payment and completed form to the address below. We also accept credit cards, contact us for details. If class is cancelled due to weather, etc. you will be rescheduled for a different class.

Full Name:

First Middle Last

Mailing Address:

Street Apt. Town State Zip

Phone #:

E-Mail:

Drivers License or State ID #:

Date of Birth:

Pick a first choice and second choice for your class below.
Place a "1" by your first choice and a "2" by your second choice.

	NE CCW Class on 07/18/2010 at 8:00 AM
	NE CCW Class on 08/08/2010 at 8:00 AM
	NE CCW Class on 08/21/2010 at 8:00 AM

We will either call or e-mail you to confirm the class date you will be attending.

Yes No

I would/would not like to eat Pizza Hut Pizza for lunch, compliments of Great Plains Rifle Works LLC.

Please make check payable to "Great Plains Rifle Works LLC" and mail with Registration Form to:

Great Plains Rifle Works LLC
3950 T Road
Bruno, NE 68014

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