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Enhanced Carry Course Online Registration Form

Please submit 1 form for each student you are registering

Registration closes at noon the day before the class. 
Once the form is submitted, you will receive a confirmation message and further instructions.


By submitting this application, the student agrees to abide by any and all safety procedures required by Brothers N Arms Gun Range.  The student also agrees to sign a statement releasing Brothers N Arms, LLC and Close Quarter Combat, LLC from any responsibility or liability for any injury the student may sustain during the training program. 


Safety is the MOST important issue and instruction may be terminated at any time if the student is determined to be unsafe to themselves and/or other students and staff.​
 

If you have any questions regarding the class you have selected, please contact the instructor by phone at (601) 325-5610 or email info@cqcselfdefense.com
PLEASE REVIEW OUR CLASS RE-BOOKING AND CANCELLATION POLICY 

COURSE NAME
ENTER THE COURSE DATE
ENTER STUDENT'S INFORMATION
ENTER MS DRIVERS LICENSE #
ENTER STUDENT'S FULL MAILING ADDRESS INCLUDING ZIP CODE
ENTER CONTACT PHONE NUMBER INCLUDING AREA CODE
ENTER STUDENT'S EMAIL ADDRESS
ENTER MAKE, MODEL, AND CALIBER OF HANDGUN USING
EMERGENCY CONTACT NAME AND NUMBER (OTHER THAN SOMEONE TAKING CLASS WITH YOU
SELECT PAYMENT AMOUNT and Pay HERE
ARE YOU LEGALLY PROHIBITED FROM OWNING A FIREARM?
REFERRED BY
QUESTIONS OR COMMENTS
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