Your Contact Information

First Name: Middle Init.: Last Name: Phone:

Street Address:

City: State: Zip Code: DOB:

Email Address:

Gender? Male Female

Are you a Member of:

The NRA? Yes No         
        If you answered Yes, please enter your NRA ID number:

The BSA? Yes No --- If yes, Council District:
        If registered with the BSA please enter your ID number:

Twin Cities Muzzleloader's? Yes No

Beaverbrook Sportsman's Club? Yes No
        If you are a Beaverbrook Member please enter your member number:

Course Selection
NRA Range Safety Officer (February 17)        This class is at Beaverbrook Sportsman's Club --- East Bethel.