Registration Form

Please print and mail with a check for $500 to:

Rogers Shooting School

1736 St. Johns Bluff Rd. 

Jacksonville, FL 32246

If you would like to pay with Visa/MC/American Express, please call (904) 646-0141 x1 x101

Name ________________________________________________

Address: ______________________________________________

_____________________________________________________

Phone # ______________________________

E-mail ________________________________

I would like to attend your (please check one) 

Basic __ Intermediate __ Advanced __   or 3 day Carbine __ Class 

(please indicate start date) ___________ , 2006

(please check )

I will stay at  the school lodge ___ or, I will make my own arrangements for lodging____

Optional shoulder weapon taught concurrently with handgun class (only one): 

Shotgun program__, or CQB 9mm carbine program___, or 5.56mm rifle program___

I will supply my own ammo_____ (Intermediate - Advanced programs only)

I would like the school to supply ammo for me ____

9mm___  .45 ACP____.  .40 S&W___ 12Gauge___ 5.56mm___

I understand that the enclosed check is considered earnest money and will be refunded if I cancel at least 60 days before the start of the intended class.  I also understand that the Rogers Shooting School can cancel a class 45 days before the start and I will be refunded any fees paid. In the event, the School cancel a class, I will be given a $100 certificate to be used toward another scheduled class.  I further understand that my balance due must be paid the first evening of class.  If I fail to attend the class all monies paid will be forfeit. 

(please sign and date)_______________________________/____/___/2007