|
CLASS
REGISTRATION FORM |
 |
| LAST
NAME: |
|
MIDDLE INITIAL: |
| FIRST
NAME: |
|
AGE:
|
DATE OF
BIRTH: |
| SOCIAL SECURITY NUMBER:
-
-
|
|
|
| EMAIL
ADDRESS: |
|
FAX
#: |
| TEL #
1: |
|
DAY
EVENING |
| TEL #
2: |
|
DAY
EVENING |
| PHYSICAL / MAILING ADDRESS:
|
| CITY: STATE:
ZIP
CODE:
- |
|
|
SECURITY COMPANY:
|
AGENCY TEL#:
|
| AGENCY ADDRESS:
|
| CITY:
STATE:
ZIP CODE:
- |
|
 |
| .:: VIRGINIA SUBJECTS |
|
01E, Unarmed Security
Officer ($90) |
|
01I, Unarmed Security
Officer In-Service ($50) |
|
|
02E, Private
Investigator ($425) |
|
02I, Private
Investigator In-Service ($100) |
|
|
05E, Arrest
Authority (05E) |
|
|
|
|
06E, Special
Conservator Of The Peace ($315) |
|
06I, Special Conservator
Of Peace In-Service ($100) |
|
|
07E, Entry
Level Firearms/Arrest Authority ($290) (Includes 1
Firearm and Ammo 38 or 9mm all others add $10.00) |
|
07R, Firearms
Re-qualification / SCOP Re-qualification ($100) |
|
|
08E, Entry Level Shotgun ($50w/07E, $75
alone) |
|
08R, Shotgun
Re-qualification ($40) |
|
|
09E,
Advanced Handgun ($250 + ammo) |
|
09R,
Advanced Handgun Re-qualification ($200+ ammo) |
|
|
13E, General
Instructor ($450.00) |
|
13I, General
Instructor In-Service ($60.00) |
|
|
14E,
Firearms Instructor ($450.00) + ammo |
|
14I,
Firearms Instructor In-service ($60.00) |
|
|
25E,
Locksmith ($200) |
|
25I,
Locksmith In-service ($85) |
|
|
|
32E, Personal
Protection Specialist ($600) |
|
32I,Personal
Protection Specialist In-Service ($200) |
|
|
35E
Electronic Technician ($200) |
|
35I
Electronic Technician In-Service
($70) |
|
|
35E/39E
Electronic Sales / Representative ($255) |
|
07E
Retraining
($170) (Wed-Fri-Sat-Sun) |
|
|
38E Central
Station Dispatcher ($125) |
|
38I Central
Station Dispatcher In-Service ($70) |
|
|
39E
Electronic Sales Representative ($125) |
|
39I
Electronic Sale Representative In-Service ($70) |
|
|
Additional
Weapon ($40) |
|
Range
Failure and Sat Classroom ($75) |
|
|
|
|
|
|
.::
SPECIALIZED
TRAINING |
|
|
Defensive
Tactics System - MDTS ($80) |
|
First Aid / CPR
/ AED (Onsite Training Available) ($70) |
|
|
Monadnock
Expandable Baton - MEB ($75) |
|
PR -
24 ($120.00) 8 hours |
|
|
Chemical
Aerosol Projector -Pepper
Spray ($125) |
|
Edged Weapon
Defense System - ($120) |
|
|
Law
Enforcement Patrol Rifle ($450.00 + Ammo 1200 rounds) |
|
Law
Enforcement Safety Act Qualification - HR 218 ($50.00) |
|
|
|
|
Utah Concealed Course
($125) |
|
|
|
|
Virginia Concealed Course
(Wed-Fri-Sat-Sun) ($170) |
|
| .:: COURSE DATE(S) |
| ENTER THE DATES FOR THE COURSE(S) YOU ARE REGISTERING FOR: |
|
|
|
|
|
|
 |
| PAYMENT TYPE: |
|
ALL
FEES ARE
NON - REFUNDABLE |
| CREDIT CARD #: |
EXP DATE:
|
| NAME ON
CARD: |
| TOTAL
AMOUNT TO BE BILLED:
|
|
|
YOUR SEAT IN
THE COURSE IS NOT GUARANTEED UNTIL FULL PAYMENT HAS BEEN
RECEIVED |
|
|
|
