SPARTAN TACTICAL                                      Tactical Firearms Training                                                                         PO Box 1319                                                Keller, TX 76244 Course Desired: __________________________________ Course Tuition:  $___________ Course Dates:________________________________ Course Location: ________________ Please complete and return w/ payment payable to:               Spartan Tactical                                                                                    PO Box 1319                                                                                    Keller, TX 76244 Name: ________________________________________________________ Agency/Organization: ____________________________________(If required for this class) Position: ______________________________________________________ Address: ______________________________________________________ City: _______________________________ State: _______  Zip: _________ Home Phone: __________________________Work Phone: ____________________________ Email: _________________________________________ If paying by credit card, complete the following: CC Type: VISA M/C (Circle One) CC Number: _______________________________ Expiration Date: ___________ Three Digit Security Code: ______ Name on Card: _________________________ Please complete the above with your billing address if paying by credit card. Student Agreement I understand that this class will involve using a deadly weapon, and that conducting proper and safe class requires all students to fully cooperate with the instructor/staff. I also understand that my participation in this course may be terminated at any time, without refund, if the course instructor or host deems my cooperation unsatisfactory. I agree to abide by all safety procedures required in the course. I also agree to sign a waiver releasing the host, instructor and facilities owner(s) from responsibility for any injury I may sustain during the training program. By signing below, I certify that I am (or will be at the time of the class), 18 years old or will be accompanied by my parent or legal guardian. I certify I am not legally prohibited from owning, operating, or being in close proximity to any firearms or ammunition. Signed: __________________________________ (Print name) ______________________________