PRE-REGISTRATION IS REQUIRED. CALL THE CLUBHOUSE AT 352-597-9931 TO REGISTER. OUR RECEIPT OF YOUR APPLICATION AND $50 FEE WILL BE YOUR CONFIRMATION IN THE CLASS.
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PLEASE COMPLETE APPLICATION AND REMIT WITH YOUR CHECK OR MONEY ORDER FOR $50.00 PRE-REGISTRATION REQUIRED PAYABLE TO - THE HERNANDO SPORTSMAN'S CLUB MAIL TO - P. O. BOX 10754, BROOKSVILLE, FL 34603-0754 Registration Fee is NOT Refundable Unless the Course is NOT Given! A Valid Driver's License must be provided. |
| Name: __________________________________________________ | Hm Ph: ____________________________ |
| Address: ________________________________________________ | Wk Ph: ____________________________ |
| City: ___________________________________________________ | Date of Birth: ______________________ |
| State: ____________________ | Zip:__________________________ |
| REASON for ATTENDING CLASS: ____________________________________________________________ |
| FIREARM YOU ARE INTERESTED IN LEARNING ABOUT: |
| Brand / Model: __________________________________________ | Caliber: _________ | Type: _____________ |
| I the undersigned hereby waive any claim or cause of action of any nature whatsoever arising as a result, or in connection with, the instructors or the use of the facilities, or arising from my presence on or about the said property or facilities of the Hernando Sportsman's Club, their representatives or instructors. |
| Date: _______________________ | Signed: ________________________________________________________ |
|
PARENT OR GUARDIAN'S |
SIGNATURE (REQUIRED IF UNDER 18 YEARS OF AGE) |
| Date: _______________________ | Signed: ________________________________________________________ |
|
================= Instructor's Use ONLY ======================= |
| Date Class Attended | Range | |
| 1. _________________________________ | Date: __________________ | |
| 2. _________________________________ | Time: __________________ |
| Instructor's Comments: ______________________________________________________ |
| PAID: Check # _____________ | Money Order # _________________________ | Cash Amount $ ____________ |