I am citizen of the United States or a lawful permanent residence and a resident of North Carolina.
I understand I have to be 21 years old to apply for the NC Concealed Carry Permit.
I am eligible to receive a handgun under NC and US Laws.
I have a valid NC or Federal Photo ID (required for certificate and permit). 
I will sign a waiver of liability.
I understand the instructor/s may excuse, dismiss or reschedule me to a later class and/or refund any part of the class fees at their discretion.
The North Carolina Concealed Carry Handgun Class is designed for persons who have some experience and proficiency with handguns. Successful completion of the course requires passing a Shooting and Handgun Proficiency Test. If you have limited or no experience with handguns, we strongly suggest that you consider taking an Extended Concealed Carry Class, a NRA Basic Pistol Class or a Coaching Session.
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NC CONCEALED.ORG MAIL IN REGISTRATION FORM
Information provided is for instructor's use and certification information only
STREET ADDRESS:
CITY:
NC DRIVERS LICENSE NUMBER:
DOB:
AGE:
EMAIL ADDRESS:
PHONE DAY:
NC
CLASS DATE REQUESTED:
PHONE EVENING:
Last
First
MI
Please bring your handgun and 60 rounds ammunition for practice and qualification.                     Please bring 3 magazines or speed loaders for your handgun if you have them.                               Bring Eye and Ear Protection (approved for shooting activities) required for all persons on the range.     Dress for the weather, we shoot outside. Wear comfortable clothing.                                                 Bring drinks or snacks if you want them. We eat lunch at a local restaurant.
INFORMATION FOR THE HANDGUN I WILL BE USING FOR QUALIFICATION
Signature
Date.
Manufacture.
Model
Caliber
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COMMENTS
Include Payment:                                                                                                                      Payable To: Paul Echols
Please print and return this completed form and payment to: Paul Echols, 5960 Woodfield Drive, Kernersville, NC 27284
NC CONCEALED.ORG MAIL IN REGISTRATION FORM