Registration Form for UNIVERSAL SHOOTING ACADEMY

Attn: Frank Garcia
(863)635-3425...or fax this form to (863)635-5277

Make check to: UNIVERSAL SHOOTING ACADEMY
Address:  4300 C.R. 630 East, Frostproof, Florida USA 33843
email:
FrankGarciaUSA@yahoo.com

When you decide on a date, check with us for availability, make a copy of the following registration form, complete it and return it to us with a $100.00 non-refundable deposit. The deposit may be made with a credit card upon the date of reservation. The additional balance will be collected upon course completion. Payment may be cash, travelers' check or credit card (see bottom of form for credit card information).

Print this 2-page form, fill out all information below, and mail with your payment to address above.


 

NAME:___________________________________________________________________

PHONE:___________________________________________

EMAIL ADDRESS:__________________________________________________________

ADDRESS:________________________________________________________________

CITY:_______________________________STATE:___________________ZIP:_______

COUNTRY:_____________________________FAX:_______________________________

WHAT DATE(S) DO YOU WANT TO RESERVE:____________________________________

WILL YOU BRING YOUR OWN FIREARM: YES______________NO________________ 
IF YES, WHAT CALIBER?___________________________________________________ 

WILL YOU BRING YOUR OWN AMMO? YES______________NO________________

WILL YOU NEED LEATHER FROM US TO COMPLETE THE COURSE?
(Holster, Belt, Magazine Pouches): YES______________NO________________
IF YES, WHAT SIZE BELT: 
30_____32_____34_____36_____38_____40_____42_____44_____

MALE___________FEMALE___________

CLUB AFFILIATION:________________________________________________________

HOW MANY YEARS HAVE YOU BEEN SHOOTING:___________________________________

DO YOU HAVE ANY COMPETITION EXPERIENCE:__________________________________

ARE YOU INVOLVED IN LAW ENFORCEMENT:_____________________________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME:_________________________________ 

AT WHICH AIRPORT (IN FLORIDA) WILL YOU BE ARRIVING: MIAMI____________ORLANDO_____________TAMPA____________OTHER______________


CREDIT CARD INFORMATION:

Circle one:  VISA   MASTERCARD

CARD NUMBER:_____________________________________________________________

CARD EXPIRATION DATE:____________________________________________________

NAME, EXACTLY AS SHOWN ON CARD:__________________________________________

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