Private Class Request Form

Contact Information

(who filled out this form)

Full Name *

Phone *

Email *

First Name of Who to Bill To *

Last Name of Who to Bill To *

Agency *

Department *

Course Type *

Course Location and State Location will be a factor or facility to rent a range. Depending on the type of class as well.

Desired Date of Class *

If desired date is not available (2nd option date)

Location will be a factor or facility to rent a range. Depending on the type of class as well.

Total of Training Days Needed *

Number of Participants *

Are you willing to take an assistant besides Dan if Dan is Booked? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.