Please PRINT OUT This Application Form, Fill It Out, and Mail It To The Address Below


NRA Personal Protection Course Application

Start Date of Requested Course: _____________


NAME: _____________________________________________________________________________

 MAILING ADDRESS: _____________________________________________________ APT #: ______

 CITY: _______________________________________________ STATE: _________ ZIP: ___________

 E-MAIL ADDRESS: __________________________________________________________________

 BIRTHDATE: _______________ WORK TEL: _________________ HOME TEL: __________________

Payment Method: qCheck or Money Order Enclosed

NOTE: Check or Money Order Should Be Made Payable To: "Media Guys Inc"

Please Mail This Completed Application Along With The Appropriate Payment To:


Jeff Weinstein, NRA Certified Chief Instructor

PO Box 373

Yarmouth ME 04096

Any Questions? Please Call 207-846-3000

Please Allow Approximately 3 To 5 Days For Processing


© 2003-2011 Media Guys Inc

Your Enrollment Will Be Acknowledged By E-Mail or Telephone