Defense Midwest LLC

DEFENSE MIDWEST LLC.

Name (print in block letters as you want it to appear on your certificate):___________________________________________________________________________________________________________________________________________________________
Current Address:_______________________________________________________________________________________________________________________________________City: ________________________________________________________________________________________ State: __________________ Zip: ______________________________Day Phone # ____________________________________________________________________________________________________________________________________________Email ____________________________________________________________________________________________________________________________________________________Course & Date Requested: ____________________________________________________________________________________________________________________________

By signing this application, I understand and agree to the following;1.        Defense Midwest’s operation depends on strict and careful control of deadly weapons by each and every student, and such control depends on the cooperation of it’s students; therefore, I understand that my instruction may be terminated, without refund, at any time during the course if the instructional staff feels that my participation or behavior is in any way inappropriate to the circumstances.2.        I fully agree to completely adhere to all safety instructions and procedures, written and verbal, as set forward by Defense Midwest and it’s staff.3.        I agree to sign a waiver releasing Defense Midwest LLC., it’s staff, and all associated entities from liability for any property loss or injury that I may sustain or cause during the training course and in travel to and from the training facility.4.        I understand that my deposit is only refundable with more than 21 days verbal or written notification prior to the start of the class. If I cancel with less than 21 days notice I agree that my deposit will be deemed non-refundable. I agree to submit all fees with this application.5.        I understand that the training provided at Defense Midwest courses are content specific and intended only to suppliment those citizens who by Federal Law can legally purchase and possess a firearm. You must be able to and certify that you can, both successfully and legally, fill out a Federal Form 4473 governing the purchase of a firearm. 
Signature: ___________________________________________________________________________________________________ Date: ___________________________________

Do you have any medical conditions that the staff should be aware of or that could affect your ability to participate: _____________________________________________________________________________________________________________________________________________________________________________Do you take any medication that the staff should be aware of: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Are you allergic to anything that the staff should be aware of: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Enclose the following1. Copy of Your Drivers License, CCH license, or other State or Federal Issued Picture ID 2. 100% deposit (cash, money order, check – there is a $30 fee on any returned checks)a. Make out payments to Defense Midwest LLC3. Completed applicationa. Mail to: Defense Midwest LLC    5615 Peddicord Rd.