________________________________________________________________________
                              Last                                                                  First                                                                              MI
                              ________________________________________________________________________
                              Address                                                           City/Town                                                               State
                              ________________________________________________________________________
                              Birthdate                                                           Social Security Number
                              ________________________________________________________________________
                              Home Phone                                                   Work Phone                                                   Cell Phone

                              U.S. Citizen:   Yes____      No____

                              Possess a valid and current LTC or FID:   Yes____   No____
                              Own firearm?  Yes____   No____
                              If Yes, what model & caliber?  __________________________ 

                              Printed Name:________________________________________ Date:__________

                              Signature:___________________________________________ Date:__________
                                                                  
                                                                     Please Read Carefully Before Signing

   I understand by signing this form this gives UPPER HAND HOME DEFENSE the right to accept or deny my application should any information be intentionally left out or misleading.  I further understand that UPPER HAND HOME DEFENSE is not held responsible for any equipment that may be lost, stolen, or broken; or any injuries that may be sustained during training. I also understand that I am not entitled a refund should I not act or conduct myself in a unsafe manner as to cause injury to myself or any other participants.  I understand this will be definate grounds for dismissal with prejudice.